A Peri-Operative Counseling Toolkit to Reduce Patient Telephone Calls

Objectives: Enhanced Recovery After Surgery, or ERAS, protocols have become an accepted part of surgical care quality improvement, and have improved outcomes for gynecological patients. Standardized counseling, as a part of ERAS protocols, has been shown to reduce patients’ perioperative stress and anxiety. At our institution, each patient has a 30-minute appointment with a fellow approximately 2 weeks prior to surgery; risk factor assessment, confirmation/ordering of indicated testing, review of pre- and post-op instructions, and study enrollment occur at this visit. The counseling given at this "PAT visit" was highly variable, and patients may not have retained the information given. We hypothesize that variability in retention manifested in increased telephone calls to the office in the peri-operative period. This study aims to examine the effect of implementation of a counseling toolkit on peri-operative calls from patients.

Methods: In collaboration with surgeons, office staff, and institutional marketing, a pre-surgical counseling toolkit was designed to standardize counseling for patients scheduled to undergo surgery with the division of Urogynecology. The toolkit, consisting of 8 leaflets enclosed in a folder, was implemented in August 2021. At each PAT visit after implementation, the folder was reviewed with the patient, and individualized with real-time markup. Charts were pulled from PAT visits for a 12-month period prior to implementation (n = 136), and for a 12-month period after implementation (n=233). Incoming phone calls in the 12 weeks prior to surgery (pre-op) calls and 12 weeks after surgery (post-op) calls were manually reviewed. Calls for appointments, cancellations, and medication refills were excluded. Phone call, demographic, procedure detail, and post-operative complication data was collected and stored in RedCAP. Kruskal-Wallis, independent t-test, and Chi-squared analysis were used to compare pre-intervention and post-intervention data.

Results: Pre-operative phone calls were reduced after implementation of the packet, from a mean of 1.19 to 0.49 calls per PAT visit (p < 0.001; hypothesis testing done on medians due to non-normal distribution of data). Post-operative phone calls were reduced but this difference was not statistically significant. As would be expected, pre-op calls regarding surgical scheduling, pre-operative clearance, medications, and leave of absence were significantly reduced. Of note, post-op calls regarding pain, pain medication, urinary difficulty, and general post-op questions were not reduced after the intervention.

Conclusions: Implementation of a standardized peri-operative toolkit can help to decrease phone call burden in the outpatient Urogynecology setting. Our iteration of the toolkit appeared more effective in reducing pre-operative phone calls directly related to the surgery, but less effective in reduction of calls related to recovery. Future iterations may include modifications to the pain and pain medication sections of the toolkit, and discharge reminders to refer to the folder with questions. A separate packet for minor procedures and sacral neuromodulation is under development.