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Original Investigation
June 2, 2021

Association Between Electronic Patient Symptom Reporting With Alerts and Potentially Avoidable Urgent Care Visits After Ambulatory Cancer Surgery

Author Affiliations
  • 1Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
  • 3Department of Anesthesiology, Weill Cornell Medical College, New York, New York
  • 4Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
  • 5Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, New York
  • 6Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Surg. 2021;156(8):740-746. doi:10.1001/jamasurg.2021.1798
Key Points

Question  Is electronic symptom reporting with clinical alerts (the Recovery Tracker) for 10 days after ambulatory cancer surgery associated with a reduction in potentially avoidable urgent care visits, defined as an urgent care visit without an admission?

Findings  In this cohort study of 7165 patients, implementation of the Recovery Tracker was associated with significantly lower risk of an avoidable urgent care visit and a modest increase in the number of nursing calls.

Meaning  Electronic symptom reporting with nursing follow-up for clinical alerts may reduce potentially avoidable urgent care visits, supporting broader implementation.

Abstract

Importance  Increasingly complex surgical procedures are being performed in the outpatient setting, increasing the burden on patients and caregivers to manage their postoperative symptoms. Electronic patient-reported symptom tracking may reduce this burden and help patients distinguish between expected symptoms and those requiring intervention.

Objective  To determine whether electronic symptom reporting with clinical alerts for 10 days after ambulatory cancer surgery is associated with a reduction in potentially avoidable urgent care visits, defined as a visit not leading to admission.

Design, Setting, and Participants  This retrospective cohort study was conducted at the Josie Robertson Surgery Center (JRSC), Memorial Sloan Kettering Cancer Center’s ambulatory surgery center with overnight stay capacity from September 20, 2016, to December 31, 2018. Patients undergoing prostatectomy, nephrectomy, mastectomy with or without immediate reconstruction, hysterectomy, or thyroidectomy at the surgery center before (n = 4195) and after (n = 2970) implementation of the Recovery Tracker (RT) electronic postoperative symptom survey were included. Data analyses were conducted from February 1 to November 24, 2020.

Exposures  A short electronic survey assessing symptoms daily for 10 days after surgery, administered via the patient portal, with alerts to the clinical team and follow-up for concerning responses.

Main Outcomes and Measures  The main outcome was Memorial Sloan Kettering urgent care center visits with and without readmission and any readmission within 30 days after surgery. Nursing workload was measured by patient phone calls, emails, and secure messages as documented in the electronic medical record.

Results  A total of 7165 patients were analyzed, including 4195 (median age, 53 [interquartile range (IQR), 44-63] years; 3490 women [83%]) from the pre-RT implementation period and 2970 (median age, 56 [IQR, 46-65] years; 2221 women [75%]) from after full implementation. On multivariable, intent-to-treat analysis by study period, having surgery in the post-RT period was associated with a 22% decrease in the odds of an urgent care center visit without readmission (OR, 0.78; 95% CI, 0.60-1.00; P = .047). Having responded to at least 1 survey was associated with a 42% reduction in the odds of an urgent care center visit without readmission (OR, 0.58; 95% CI, 0.39-0.87; P = .007). There was no change in the risk of admission. Nursing calls increased by a mean of 0.86 (95% CI, 0.75-0.98) calls per patient after RT implementation (P < .001), a 34% increase.

Conclusions and Relevance  In this cohort study, electronic symptom reporting with nursing follow-up for clinical alerts was associated with a reduction in potentially avoidable urgent care visits. The low risk and high benefit of this intervention suggest that these systems should be more broadly implemented.

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