title: Implementation of a Telephone Postoperative Clinic in an Integrated Health System.
abstract: Earlier work suggested that telephone follow-up could be used in lieu of in-person follow-up after surgery, saving patients time and travel and maximizing use of scarce surgeon and facility resources. We report our experience implementing and evaluating telephone postoperative follow-up within an integrated health system.
  
  
  
  We conducted a pre-post evaluation of a general surgery telephone postoperative clinic at a tertiary care Veterans Affairs facility from April 2015 to February 2016. Patients were offered a telephone postoperative visit from a surgical provider in lieu of an in-person clinic visit. Telephone clinic operating procedures were refined through iterative cycles of change using the Plan-Do-Study-Act method. The study period included 2 months pre-intervention and 9 months post-intervention. The primary end point was mean number of clinic visits per eligible patient before and after telephone clinic implementation. Secondary outcomes were rates of emergency department visits and readmissions before vs after telephone clinic implementation and complication rates in patients scheduled for telephone vs in-person postoperative care.
  
  
  
  During the study period, 200 patients underwent eligible operations, 29 pre-intervention and 171 post-intervention. In-person clinic use decreased from 0.83 visits per eligible patient pre-intervention to 0.40 after implementation of the telephone clinic (p < 0.01). There was no difference in rates of emergency department presentation or readmission in eligible patients (0.17 visits/patient pre-intervention vs 0.12 post-intervention; p = 0.36). Complication rates were comparable for eligible patients who were and were not scheduled for telephone care (6% vs 8%; p = 0.31).
  
  
  
  Telephone postoperative care can be used in select populations as a triage tool to identify patients who require in-person care and decrease overall in-person clinic use.
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: kristy.l.kummerow@vanderbilt.edu.
authors.forename: Kristy
authors.initials: K
authors.lastname: Kummerow Broman
authors.affiliation: Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Stewart
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Castellanos
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: John L
authors.initials: JL
authors.lastname: Tarpley
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Pierce
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods* / Q000458:organization & administration; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration; D013689:Telephone; D013714:Tennessee