Nurse Practitioner-Led Postoperative Telehealth for Hepato-Pancreato-Biliary Surgical Oncology Patients

Background: Hospitals frequently performing hepato-pancreato-biliary (HPB) surgeries are positioned to mitigate complications and readmissions. The project was implemented at a mid-Atlantic quaternary care academic health system with National Cancer Institute Comprehensive Cancer Center designation.

Local Problem: No consensus guidelines outline strategies to identify HPB postoperative concerns post-discharge. Therefore, this quality improvement project standardized early identification of surgical site infections (SSIs).

Methods: Plan-Do-Study-Act (PDSA) was the applied implementation model. Telehealth visits were incorporated for earlier detection of SSIs and to promote patient satisfaction.

Interventions: Nurse practitioner-led telehealth visits were conducted within five days post-discharge. A standardized in-visit documentation tool and post-visit patient satisfaction survey were utilized for evaluation.

Results: Thirty-six telehealth visits were conducted; one SSI was identified during a telehealth visit and eight identified in total. 88% (n=7) of SSIs were readmitted. Whipple surgery patients (62.5%, n=5) and incisional drainage (n=3) were the most common SSI indicators. Survey respondents (n=28) validated usefulness and satisfaction with visits.

Conclusions: Nurse practitioner-led telehealth identifies SSIs and positively impacts patient satisfaction in the post-discharge period. Prevention of one SSI readmission resulted in significant net cost savings. The project’s telehealth model is adaptable for utilization by other surgical oncology teams across a health system.