Background Moore et al.1 reported that nurse led initiatives can reconfigure care, making it more responsive to individual needs, increasing patient satisfaction and reducing hospital visits. Nurse-led telephone follow up clinics post surgery have evidence of patient satisfaction and reduction in post-op complications,2 but this is not a routine intervention post thoracic surgery. Prior to establishing our clinic, patients were discharged after thoracic surgery with a surgical outpatient appointment at 6 weeks and no routine community follow up. These patients had often undergone complicated surgery, and been discharged with chest drains or on strong opioids.
Methods All patients discharged after surgery were contacted by telephone up to a maximum of a week after discharge with a further follow up call 2 weeks later if needed. A protocol of open questions was used to identify post-op difficulties at an early stage, facilitate referral to community teams, improve patient experience and provide additional information.
Results and conclusion 29 patients were contacted over a 6 month period, following discharge after thoracic surgery; VATs, lobectomy, sleeve/wedge resection, pneumonectomy and pleurectomy. Each call lasted up to 20 min, equating to a maximum 10 h of nurse time.
Telephone clinic highlighted a number of medical issues that required intervention and prevented GP and hospital appointments/admissions. Commonly reported symptoms included pain, shortness of breath, fatigue, constipation, weight loss and inability to sleep. In most cases simple advice and reassurance could be given. In 3 cases, medication was organised (antibiotics, laxatives, analgesia). A referral to the GP or community services was organised in 4 cases. Patient satisfaction was high however further evaluation over a longer period is needed. Additional study is necessary to explore the cost implications and the monetary value of avoiding admissions.
References 1 Moore S, Corner J, Haviland J, et al. Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial. BMJ 2002;325:1145
2 Young JM, Butow PN, Walsh J, et al. Multicenter randomized trial of centralized nurse-led telephone-based care coordination to improve outcomes after surgical resection for colorectal cancer: The CONNECT intervention. J Clin Oncol. 2013;31:3585–91