Authors (including presenting author) :
Leung KW(1), Leung KC(1), Au Yeung SYS(1), Tong WC(1), Lee SH(1), Choi YY (1), Koon NF(1), Chan PK(1)
Affiliation :
(1) Department of Orthopaedics & Traumatology, Queen Mary Hospital
Introduction :
From 2016 to 2020, average length of stay of joint replacement surgery patients in Queen Mary Hospital decreased from 10.5 days to 6.86 days. Patients are being discharged early in post-operative stage. They may have inadequate preparation for physical and psychological reactions. For example, difficult to transfer acquired health information to home setting, needed further guidance at home and reluctant to take initiative to contact nurses etc. This may increase the risk of complications and readmission rate post operatively. Hence, a proactive telephone follow-up program was introduced in 2019.
Objectives :
(1) To recognize patients’ post discharge condition and associated complications.
(2) To minimize unplanned readmissions through service enhancement.
Methodology :
A nurse clinic follow-up will be arranged for patients 2 weeks after surgery. Two telephone follow-up will be provided proactively before and after the nurse clinic appointment. Patients will be interviewed by nurses with questionnaire in different aspects via telephone follow up. For example, pain level, wound condition, compliance of post-operative exercise etc. Patients can call the hotline for post-surgery enquiries whenever they need.
Result & Outcome :
Total 185 telephone follow- up were conducted from 2019 to 2020 with 90% of response rate. 88.4% of patients could keep their dressing intact and dry. Besides, 97% of patients without wound complications, 19% with analgesic side effect such as constipation, nausea & vomiting. Mean pain score progressively decreased from 4.53 to 2.29 after patients discharged home. Patients mainly concerned about the operated limbs condition (19.5%) and wound condition (14%). Furthermore, nurses identified problems such as, patients forgot pre-operative education, managed wound by themselves, discharge from unhealed wound, non-compliance to drug regimen, ice therapy and post-operative exercise etc. Overall, 83% of patients were satisfied with telephone follow up service with average score 7.94 out of 10. Additionally, the unplanned readmission rate decreased from 3.1% in 2018 to 2.76% in 2019 and 2.9% in 2020 after the implementation of telephone follow-up.
Conclusion:
Patients needed physical and psychological support while they were being discharged in early post-operative stage. Proactive telephone follow- up provided post discharge monitoring, improve patients’ knowledge in pain medication, wound care and physical exercise etc. Reinforcement of post-operative information and education are essential as to decrease unplanned readmission and post-discharge complications.
