A Mobile Phone App Improves Patient-Physician Communication and Reduces Emergency Department Visits After Colorectal Surgery

Abstract

BACKGROUND: Emergency visits after colorectal surgery are common and require significant health care resources. However, many visits may be avoidable with alternative access to care. Mobile health technologies can facilitate patient access to health care providers. OBJECTIVE: We hypothesized that a mobile app for postdischarge monitoring with patient-provider communication ability would reduce emergency visits after elective abdominopelvic colorectal surgery. DESIGN: This is a prospective cohort study with a regression analysis after coarsened exact matching. SETTING: The study was conducted at a single colorectal referral center from May 2019 to September 2020. PATIENTS: A total of 114 patients were recruited to the intervention and were matched to a retrospective cohort of 608 patients from the 24 months before the study. All patients were managed according to an enhanced recovery pathway. INTERVENTIONS: A mobile phone app comprised of patient education material, daily questionnaires assessing postdischarge recovery, and patient-provider chat function was used. MAIN OUTCOME MEASURES: The primary outcomes included potentially preventable 30-day emergency visits defined according to a validated algorithm. Secondary outcomes included length of stay, complications, total emergency department visits, readmissions, and app usability. RESULTS: Coarsened-exact matching resulted in a matched sample of 94 prospective intervention patients and 256 retrospective control patients. The prospective group was associated with fewer preventable emergency department visits (incidence rate ratio 0.34; p = 0.043) and shorter length of stay (-1.62 days; p = 0.011). There were no differences in 30-day complications, total number of emergency visits, or readmissions. Patient-reported usability of the mobile app was high, with 88% of patients reporting that the app improved their ability to communicate with their surgeon. LIMITATIONS: We did not account for patient activation or perform a cost-analysis. CONCLUSION: Use of a mobile app was associated with fewer potentially preventable emergency visits and shorter length of stay after major elective colorectal surgery, which may be due to enhanced postdischarge monitoring and patient-provider communication. See Video Abstract at http://links.lww.com/DCR/B878. APLICACIÓN DE TELÉFONO MÓVIL MEJORA LA COMUNICACIÓN ENTRE MÉDICO Y PACIENTE Y REDUCE LAS VISITAS AL DEPARTAMENTO DE EMERGENCIAS DESPUÉS DE CIRUGÍA COLORECTAL ANTECEDENTES: Las visitas de emergencia después de la cirugía colorrectal son frecuentes y requieren importantes recursos sanitarios. Sin embargo, muchas visitas pueden evitarse con un acceso alternativo a la atención. Las tecnologías de salud móviles pueden facilitar el acceso de los pacientes a los proveedores de atención médica. OBJETIVO: Se planteó la hipótesis de que una aplicación móvil para el seguimiento posterior al alta con capacidad de comunicación entre el paciente y el médico reduciría las visitas de emergencia después de cirugía colorrectal ab...

Enhanced Recovery 2.0 – Same Day Discharge With Mobile App Follow-up After Minimally Invasive Colorectal Surgery

“…In the control study period, there were 290 eligible colorectal resections, of which 185 were approached to participate in the mobile phone app study and 114 consented. 12 There were 73 patients within this control cohort that met the SDD study eligibility criteria (standard ERP cohort). Characteristics of these patients are shown in Table 2.…”

“…In a pilot trial before the implementation of SDD colectomy, the use of this smart phone app was associated with reduced ED visits compared to historical controls. 12 Patients who were enrolled in that pilot trial also reported high satisfaction with the smart phone app and felt more secure after discharge because of the ability to easily communicate with their provider. Similarly, in the present study, most SDD patients reported that their questions and concerns were able to be remotely managed.…”

“…Clinical outcomes were compared between SDD patients and a cohort of patients operated on between May 2019 to March 2020 who were not discharged on the same day, but were also offered the same postdischarge remote monitoring mobile app as part of a different study. 12 In this cohort, patients were managed with our standardized long-standing ERP with a 3-day target LOS (see eTable 1, Supplemental Digital Content 2, http://links.lww.com/SLA/D160). 13,14 To create an appropriate comparison group, the SDD inclusion and exclusion criteria were applied retrospectively to this cohort.…”

Same day discharge following elective, minimally invasive, colorectal surgery

“…Based on these data, Lee and colleagues implemented an mHealth smartphone application for remote follow-up after elective colorectal resection to investigate its effect on post-discharge outcomes and its usability. In this study, use of a smartphone app for remote follow-up was associated with a significant reduction in preventable Emergency Department (ED) visits (IRR 0.34, 95%CI 0.12–0.97) and was associated with high usability and patient satisfaction [ 42 ]. This experience confirmed that patients were able to reliably convey important symptoms and concerns through the app in the post-discharge setting.…”

“…Amongst the open-ended reports of patient experiences, only four patients expressed pain issues in the first 72 h, although none requested additional analgesics. In particular, the use of a mHealth app for remote follow-up was associated with improved patient-physician communication post-discharge, which is essential for SDD [ 42 ]. Patients felt more secure after discharge because of the ability to easily communicate with their provider.…”