title: Outpatient virtual clinical encounters after complex surgery for cancer: a prospective pilot study of "TeleDischarge".
abstract: BACKGROUND
  Outpatient clinical encounters are used to promote recovery after complex surgical procedures for cancer. These care episodes are resource intensive. Virtual clinical encounters (VCEs) can now be conducted using widely available videoconferencing technologies. However, whether these technologies may be used to monitor postoperative recovery is unknown.
  
  
  METHODS
  In this pilot study, we provided care using a comprehensive "TeleDischarge" protocol to 15 patients after pancreatectomy. In addition to routine follow-up, all patients participated in two scheduled and an unlimited number of unscheduled VCEs using mobile hardware and secure videoconferencing software. We evaluated feasibility, patient satisfaction, postoperative adverse events, and health care human resource utilization.
  
  
  RESULTS
  The median age of enrolled patients was 63 y (range, 52-83 y) and 93% underwent pancreatoduodenectomy. Twenty-eight scheduled VCEs (93%) were completed successfully, and only one unscheduled VCE was requested. Twelve patients (80%) felt their postoperative care was enhanced by VCEs and 14 (93%) felt that VCEs should be a regular part of postoperative care. Minor interventions in four patients (27%) were performed on the basis of clinical data gathered during a VCE. On a per patient basis, the TeleDischarge pathway was estimated to take 36 min longer and to have a direct labor cost $39 greater than the standard pathway.
  
  
  CONCLUSIONS
  Secure VCEs can be conducted using widely available hardware and software solutions. Although cancer patients support the introduction of mobile technology into postoperative care, further studies are needed to identify ways in which such technology can be used most effectively and efficiently to reduce barriers to recovery.
authors.affiliation: The Minimally Invasive New Technologies in Oncologic Surgery (MINTOS) Cooperative Group, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: mhgkatz@mdanderson.org.
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Slack
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Morgan
authors.initials: M
authors.lastname: Bruno
authors.affiliation: The Minimally Invasive New Technologies in Oncologic Surgery (MINTOS) Cooperative Group, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jermaine
authors.initials: J
authors.lastname: McMillan
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.affiliation: The Minimally Invasive New Technologies in Oncologic Surgery (MINTOS) Cooperative Group, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Bednarski
authors.affiliation: The Minimally Invasive New Technologies in Oncologic Surgery (MINTOS) Cooperative Group, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Papadopoulos
authors.affiliation: The Minimally Invasive New Technologies in Oncologic Surgery (MINTOS) Cooperative Group, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010351:Patient Discharge; D017060:Patient Satisfaction; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D017216:Telemedicine / Q000379:methods*; D049269:Videoconferencing
keywords: TeleDischarge; Telehealth; Telemedicine