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INTRODUCTION: Ensuring patients follow preoperative and postoperative instructions is vital for maximizing surgical success. This pilot study investigates the feasibility of using monetary incentives through a nudge engine application-based model of omnichannel communication to prompt adherence to preoperative and postoperative instructions. METHODS: Over a six-month period, we conducted a longitudinal study employing the TheraPay® Rewards app at Maimonides Medical Center in Brooklyn, United States. Our recruitment efforts targeted English and Spanish-speaking patients with smartphones through in-person visits and phone calls. Participants received a $15 credit on a gift card for each completed task. The tasks included preoperative validations such as obtaining primary care physician clearance, completing preoperative assessments, undergoing preoperative scans with accompanying compact disks (CDs), and discontinuing specific medications. Postoperative validations included attending postoperative visits, proper incision care, discontinuation of narcotics at three weeks, and initiation of the first physical therapy session. RESULTS: We enrolled 16 patients with a mean age of 59.5 years (SD 11.68), the majority being male (n = 10, 62.5%). Preoperatively, task completion rates ranged from 83% to 100%. Postoperatively, rates varied from 20% to 100%. Preoperative task adherence averaged at 98.7% (SD 2.2%), while postoperative adherence averaged 60% (SD 21%). CONCLUSION: Our study indicates that financial incentives delivered through a gamified approach effectively encourage patients to complete essential preoperative tasks, suggesting a promise for enhancing adherence. Nonetheless, the decrease in postoperative task adherence highlights the necessity for careful implementation. Future investigations should compare cancellation rates and outcome measures to gain deeper insights into the effectiveness of app-based incentives in improving surgical outcomes and patient adherence.
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INTRODUCTION: Accurate medical documentation is important in the perioperative period, ensuring the safe transfer of information between teams involved in the surgical patient's care. This has been highlighted by multiple standards of care guidelines within the United Kingdom. The use of standardized pre-templated documents has displayed significant success in minimizing errors during the admission and operative stages. The aim of this study is to evaluate whether a similar proforma for the post-operative stage is successful in orthopedic patients. METHODS: A retrospective review of 25 consecutive orthopedic elective patients was conducted during the first cycle. Exclusion criteria included patients who were under 16, day case procedures, and admission due to trauma. The second cycle consisted of a prospective review of 25 patients a month following the implementation of the new proforma. Both cycles were scored against 10 inclusion parameters as outlined by national guidelines. RESULTS: Implementation of the proforma resulted in a significant improvement in post-operative note compliance. A total of six parameters showed a statistically significant improvement (p<0.05). This included wound assessment (58.3%-100%, p<0.001), post-operative imaging (37.5%-92%, p<0.001), neurovascular assessment (83.3%-100%, p=0.017), National Early Warning Score (25.0%-100%, p<0.001), venous thromboembolism prophylaxis (29.2%-96.0%, p<0.001), and antibiotic administration (4.2%-84.0%, p<0.001). CONCLUSIONS: Monitoring of important clinical parameters significantly improved following the implementation of the post-operative proforma. These results will hopefully cause the introduction of other proformas in other surgical specialties and other units.
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Introducción: la exodoncia presenta diversos factores que influyen en el éxito del período postoperatorio. El aprendizaje de las indicaciones postoperatorias ha evidenciado influir en la morbilidad, complicaciones y calidad de vida del paciente durante sus cuidados postoperatorios. Sin embargo, la estrategia de aprendizaje convencional para entregar las instrucciones postoperatorias verbal-escrita (VE) no toma en cuenta el posible compromiso cognitivo, psicológico y emocional del individuo, realizando una entrega de instrucciones indiferente al estado del paciente. Materiales y métodos: los pacientes serán asignados aleatoriamente a grupos divididos según estrategia de aprendizaje utilizada: convencional VE y psicopedagógica visual, auditiva y kinésica (VAK). Inmediatamente posterior al procedimiento se realizará la explicación de los cuidados postoperatorios según grupo. Se realizará una encuesta inmediatamente posterior a la entrega de instrucciones, luego a las 24 horas y a los 7 días luego de la cirugía, con el objetivo de evaluar el grado de retención. Finalmente, para comparar, se contrastaron las medias de cada grupo en los tres tiempos de aplicación. Resultados: se observa una media mayor en el grupo VAK, visible en todos los tiempos de aplicación, donde observamos una tendencia a presentar mejores niveles de retención. Diferencias aun no estadísticamente significativas, ya que la muestra aún no representa el total del muestreo calculado. Discusión: los resultados preliminares nos muestran que la estrategia visual-kinésica-auditiva es superior a la convencional en cuanto a nivel de retención, lo cual podría convertirla en un método de elección al momento de entregar indicaciones post exodoncia, para tener un resultado postoperatorio óptimo.
Introduction: Tooth extractions present several factors that affect the success of the postoperative period. The correct learning of the postoperative instructions has shown to affect the morbidity, complications, and quality of life of the patient after the surgery. Neverthe-less, the conventional verbal-written (VW) learning strategy to give the postoperative indications doesn't consider the possible cognitive, psychological and emotional compromise of the patient. Methods: The patients were assigned randomly into two groups, according to the learning strategy used: conventional (VW) and a psycho-pedagogical visual, auditive, and kinesic learning strategy (VAK). After extraction, the patients were explained about the postoperative care, according to the group they belonged to. A survey was conducted immediately, one day, and seven days after the procedure to record the grade of retention of the information. The means of each group were compared. Results: A higher mean was observed in the VAK group, which is visible in all the application times, determining a tendency to present better levels of retention of the information. The differences are not yet statistically significant, as the sample does not represent the total of patients previously considered. Discussion: The preliminary results show that the VAK strategy is superior to the conventional one regarding the level of retention of the information, becoming the method of choice when giving postoperative indications after dental extractions to develop a more optimal postoperative result
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INTRODUCTION AND HYPOTHESIS: There is little information on the impact that postoperative instructions have on physical activity to help guide physicians in providing these recommendations after surgery. Our study objective was to evaluate the impact of postoperative instructions on physical activity. We hypothesized that there would be no differential effect of instructions on activity. METHODS: In this randomized controlled trial, patients undergoing prolapse repair were randomized to receive either liberal or restricted postoperative activity instructions between February 2017 and February 2019. Physical activity was measured using the Activities Assessment Scale (AAS) and tri-axial accelerometers measured at baseline and 2 and 6 weeks after surgery. A sample size of 146 patients was planned to compare these activity measurements. AAS scores and accelerometer readings of the two groups were compared using separate variance t tests. RESULTS: A total of 157 women were recruited between February 2017 and February 2019, including 146 patients with completed study data (n = 72 liberal, n = 74 restricted). There was no difference in physical activity at 2 weeks between the liberal and the restricted instruction groups, as measured by AAS scores (70.47 ± 12.83, 69.54 ± 12.22, p = 0.66), total steps (4,582.20 ± 2,164.5, 5,014.47 ± 3,025.46, p = 0.32), active minutes (4.22 ± 6.17, 4.96 ± 9.65, p = 0.25), and 10-min intervals (0.76 ± 1.11, 0.77 ± 0.93, p = 0.95) respectively. Similarly, there was no difference in activity at 6 weeks between the liberal and the restricted instruction groups. as measured by AAS scores (81.86 ± 8.25, 81.31 ± 10.31, p = 0.72), total steps (6,316.25 ± 3,173.53, 6,589.94 ± 3,826.43, p = 0.64), active minutes (8.79 ± 10.5,11.36 ± 18.18, p = 0.98), and 10-min intervals (1.37 ± 1.34, 1.34 ± 1.40, p = 0.89) respectively. CONCLUSION: Postoperative instructions do not have an impact on physical activity measures in patients who have undergone pelvic reconstructive surgery.
