In the News
Patients prefer the convenience of outpatient surgery to staying overnight in the hospital. Surveys show, however, that ambulatory care patients would like to know more about what to expect during surgery and how to prepare for or treat postoperative symptoms like pain and nausea. Research shows that patients and their families also feel unprepared for unexpected consequences like isolation or the inability to perform daily tasks during home recovery. According to a new study, patients' experiences after outpatient knee arthroscopy improve when nurses telephone them during the early postoperative period.
A group of 52 patients who received telephone follow-up reported fewer symptoms of distress 72 hours and one week after surgery, compared with 50 patients who didn't receive telephone support. The nurse-coached group also had better physical and mental health scores one week after surgery. In both groups, about 60% were female and mean age was mid-40s; most were college educated, a majority were married, and almost all had at least one comorbid condition. Symptoms of distress included nausea, insomnia, pain, fatigue, and constipation.
"The telephone calls were very effective for the intervention group," says study leader Dorothy Jones, professor at Boston College's William F. Connell School of Nursing.
Nurses took three two-hour classes to train as telephone coaches. A pilot study had identified common postoperative problems, such as pain, vomiting, nausea, and constipation, and protocols were created to help nurses assess for and treat these common conditions. For instance, pain problems often resulted from patients not taking the entire amount of prescribed medications or waiting until pain was severe to start taking pain medication. The nurse coaches reviewed dosages and instructed patients to take the correct dosage. The nurses couldn't prescribe medication, but they could refer patients to a physician if needed.
Almost 70% of elective surgery is now performed at ambulatory clinics, and Jones says that the program "could be extended to other types of patient populations and could be enhanced to include home visits." Nurse-led telephone coaching could benefit other types of patients discharged from day surgery to home care, according to Jones, and nurses could monitor oncology patients after chemotherapy or radiation treatments with telephone calls. "The protocols would change," she says, "but the process is the same and outcomes should be successful."—Carol Potera