Evidence Informed Decision Making Scenario
You are the Chief of Operations of an acute tertiary hospital in inner Melbourne. Your
hospital’s routine practice is for all elective surgical patients to be reviewed in person by
the treating surgeon or member of the surgical team, generally within the first two weeks
after their surgical procedure and post-discharge from hospital.
One way the ‘quality’ of the surgery and care provided is measured is by reviewing the
number of patients who present with post-surgical complications (e.g. bleeding,
infection) within 30 days of discharge from hospital. Currently, your hospital is performing
very well, with the rate of post-surgical complications within 30 days of discharge
consistently below the Victorian state benchmark.
Due to the impact of the COVID-19 pandemic on acute services, your hospital is required
to deliver some non-urgent outpatient appointments via telehealth. You are responsible
for the operations of the hospital and have been tasked with helping the surgical services
transition to telehealth for non-urgent post-operative appointments.
You are aware that telehealth or ‘virtual care’ offers many benefits for the right patient
population. Regional patients who already receive telehealth services from your hospital
have consistently reported high levels of satisfaction in patient experience surveys.
However, this telehealth service is not currently available for post-surgical patients at
your hospital and the safety of this model of care has not previously been investigated.
At the most recent ‘Hospital Executive Huddle’, a distinguished Professor of Surgery and
Head of Department expressed his reservations, commenting that there is a risk that
‘patient safety may be compromised’ and ‘potentially missing post-operative
complications’ with telehealth visits.
The CEO has requested that you consider the available evidence to determine the
appropriateness of telehealth services for non–urgent post–operative surgical care at
your hospital. She takes you aside and stresses that “whichever way you recommend,
there should be no increase in the number of post–operative surgical complications,
otherwise we will never hear the end of it.”
Assume that the only evidence that exists in the world are in the following two papers:
1. Harkey K, Kaiser N, Zhao J, Hetherington T, Gutnik B, Matthews BD, Kelz RR,
Reinke CE. Post–discharge Virtual Visits for Low–risk Surgeries: A Randomized
Noninferiority Clinical Trial. JAMA Surg. 2021 Mar 1;156(3):221–228. doi:
10.1001/jamasurg.2020.6265. PMID: 33439221; PMCID: PMC7807392.
2. Healy P, McCrone L, Tully R, et al. Virtual outpatient clinic as an alternative to an
actual clinic visit after surgical discharge: a randomised controlled trial. BMJ Quality
& Safety 2019;28:24–31. https://qualitysafety.bmj.com/content/28/1/24
Using your critical appraisal skills, write a report to the CEO and Hospital Board advising them that you support or reject the implementation of a telehealth for non–urgent post–surgical outpatient appointments at your hospital.
(max 1500 words)