Virtual Visits (Utilization of Virtual Care in Postoperative Patients to Improve the Patient Experience)

Participants will be randomized to complete either a postoperative follow-up visit using virtual care technology or by attending a standard in-person visit at the clinic. The virtual visit uses a camera-enabled device and internet access to provide live access to the medical professional. Surveys to assess patient satisfaction and convenience will be administered by email on the day of the postoperative follow-up visit. Additional information including demographics, hospital encounters within 30 days of surgery, length of time of the follow-up visit, travel cost and time, whether additional follow-up care is required, and complications after surgery will be collected to evaluate postoperative virtual care visits. Subject participation in the study will end after follow-up care is complete or at 30 days, whichever occurs last.

• Virtual Visit (Other): Participants will be given information about how to enroll in virtual care. Participants will use their own camera-enabled device with internet connection to see and speak to the medical professional in real-time and complete the virtual follow-up visit.

Primary outcomes

• Composite measure of the occurrence of hospital encounters [from date of surgery until the date of 30 days after surgery]: composite measure of the occurrence of hospital encounters for the 30 days following surgery including all-cause and any-site inpatient, observational, and emergency department visits within Carolinas HealthCare System

Secondary outcomes

• Postoperative follow-up visit time length in minutes [date of follow-up visit, approximately 14 days after date of surgery]: total time of postoperative follow-up visit in minutes
• Patient satisfaction score [date of follow-up visit, approximately 14 days after date of surgery]: self-reported patient satisfaction rating for follow-up visit assessed by survey
• Patient convenience score [date of follow-up visit, approximately 14 days after date of surgery]: self-reported patient convenience rating for follow-up visit assessed by survey
• Rate of postoperative follow-up [date of follow-up visit, approximately 14 days after date of surgery]: percent of patients who receive a postoperative follow-up visit
• Rate of postoperative no-shows [date of follow-up visit, approximately 14 days after date of surgery]: percent of scheduled postoperative follow-up appointments in which patients do not complete
• Patient travel time to clinic in minutes [date of follow-up visit, approximately 14 days after date of surgery]: total patient travel time from home to postoperative follow-up clinic in minutes
• Patient cost savings in dollars [date of follow-up visit, approximately 14 days after date of surgery]: Patient gas cost savings for travel from home to postoperative follow-up clinic

Sex: All, ages: 18 Years to 90 Years

Inclusion Criteria:

* Willing to comply with all study procedures and be available for the duration of the study
* English speaking
* Able to read
* Have an email address
* Scheduled to undergo a laparoscopic appendectomy, laparoscopic cholecystectomy or robotic cholecystectomy OR have undergone an unplanned (urgent or emergent) laparoscopic appendectomy, laparoscopic cholecystectomy, or robotic cholecystectomy
* Have surgery performed by a surgeon at either Carolinas Medical Center-Main or Carolinas Medical Center- Mercy who provides emergency general surgery clinical coverage
* Live in North Carolina or South Carolina

Exclusion Criteria:

* Unable to complete a virtual visit (due to lack of appropriate technology, necessary technology skills, other);
* Medical condition, laboratory finding, or physical exam finding that precludes participation (patients at high risk for complications, particularly those with perforated appendicitis, patients with active cocaine abuse)
* Postoperative length of stay greater than or equal to 4 days
* Discharged with drains that need to be removed at a postoperative visit
* Admitted from or discharged to assisted living facility, skilled nursing facility, or location other than home
* Have chronic pain for which the participant takes narcotic medication

• Results publication: Harkey K, Connor CD, Wang H, Kaiser N, Matthews BD, Kelz R, Reinke CE. View from the Patient Perspective: Mixed-Methods Analysis of Post-Discharge Virtual Visits in a Randomized Controlled Trial. J Am Coll Surg. 2021 Nov;233(5):593-605.e4. doi: 10.1016/j.jamcollsurg.2021.07.688. Epub 2021 Sep 9. PMID 34509613
• Results publication: Harkey K, Kaiser N, Zhao J, Hetherington T, Gutnik B, Matthews BD, Kelz RR, Reinke CE. Postdischarge 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

• Informed Consent Form (PDF, 2019-07-09)

• Caroline Reinke, MD, Principal investigator, Wake Forest University Health Sciences