RESUMEN
BACKGROUND AND PURPOSE: Integration of information technology (IT) with health care improvement is ever increasing. National initiatives, such as Transforming Care at the Bedside, and physician-nurse collaboration committees use IT to enhance patient care. We sought to determine the impact of "video rounding" on the post-operative care of endourologic inpatients. PATIENTS AND METHODS: Laptop computers with built-in Webcam and video conferencing software were used for real-time video and audio connections between patient and nurse at the bedside and urologist at a remote location. This video rounding system (VRS) was used in addition to standard rounds. Ten patients were randomly selected and consented to participate with one of two surgeons. Post-VRS surveys with six questions each were completed by patient, physician, and nurse using a 5-point Likert scale. RESULTS: Ten physician, 10 patient, and 14 nursing surveys were filled for 10 patients who completed VRS. Of these patients, 90% strongly agreed/agreed that they could easily communicate with their physician using VRS. All patients strongly agreed that VRS should be a regular part of patient care and that they would be comfortable using VRS if their physician was unable to be in direct contact with them. All physicians and nurses strongly agreed/agreed that VRS was easy to use, enhanced patient care, would be a comfortable alternative if direct physician contact was not possible, and that it should be a regular part of institutional care. For all participants, video and audio quality were rated excellent/very good by 91.2% and 70.6%, respectively. CONCLUSION: VRS has shown promising usefulness in enhancing patient care and improving communication between nurse, physician, and patient. VRS is not intended to replace daily face-to-face physician rounding. Additional features of this system are currently being evaluated, including four-way simultaneous video rounding as well as sending intraoperative photos and video clips for real-time patient/nurse education.
Asunto(s)
Atención al Paciente , Telemedicina/métodos , Grabación en Video , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: As life expectancy continues to increase, we will be faced with the need to counsel older patients on the risks and benefits of undergoing surgery. It is clear that laparoscopic renal surgery has significant benefits over open renal surgery. However, contemporary data on whether these benefits carry over to the elderly is less robust. The objective of this study is to compare the perioperative outcomes of laparoscopic nephrectomy in patients age 70 and over to those under age 70. Outcomes from the study can be used to assist in preoperative counseling for older patients. PATIENTS AND METHODS: Between February 2000 and December 2005, 405 consecutive patients underwent laparoscopic nephrectomy for benign or malignant conditions. To decrease selection bias, kidney donors, bilateral nephrectomies, partial nephrectomies, as well as patients under the age of 17 were excluded. Laparoscopic nephrectomies included simple nephrectomies, radical nephrectomies, and nephroureterectomies. A total of 158 patients were included in the analysis. Patient demographics and perioperative data were recorded prospectively. The preoperative American Society of Anesthesiologists (ASA) score was used to reflect patient co-morbidity. Subset analysis between pure laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) was also performed. RESULTS: Average hospital stay for patients 70 years and older was 3.6 days versus 2.6 days for their younger counterparts (p = 0.02). All other demographic and perioperative parameters were comparable between groups, including incidence of intraoperative or postoperative complications, blood transfusions, and conversions to open surgery. In a subset analysis of patients undergoing HALN, despite having similar co-morbid conditions (ASA score 2.57 vs. 2.56, p = 0.9), the elderly group had a significantly increased length of stay compared to patients younger than 70 years (3.0 vs. 4.2 days, p < 0.05). However, in the group undergoing LN, there was no statistically significant difference in hospital stay (3.1 vs. 2.4 days, p = 0.22), despite the older group having higher co-morbid conditions (ASA score 2.55 vs. 2.10, p < 0.01). CONCLUSION: Other than an increased hospital stay by one day, patients 70 years and older undergoing laparoscopic nephrectomy can expect comparable perioperative outcomes to those achieved in younger patients. Such differences in the length of hospital stay may be mitigated by pure laparoscopic nephrectomy as opposed to hand-assisted laparoscopic nephrectomy in patients 70 years or older. These data may be useful in preoperative decision-making and counseling in this growing subset of patients.