# Enhancing Postoperative Virtual Visits in Vascular Surgery: A Quality Improvement Initiative Amidst COVID-19

## TL;DR

This paper describes a quality improvement initiative that successfully increased the use of virtual postoperative visits in vascular surgery during the COVID-19 pandemic.

## Contribution

The study introduces a targeted quality improvement initiative that significantly increased virtual visit adoption and demonstrated its effectiveness in reducing complications and no-shows.

## Key findings

- Postoperative virtual visit rates increased from 30% to over 50% following the interventions.
- Virtual visits were associated with reduced clinic no-shows, 30-day readmissions, and surgical site infections.
- The teach-back method proved effective in educating elderly patients on virtual visit technologies.

## Abstract

Introduction: In the realm of healthcare, virtual care has emerged as a pivotal tool for patient-provider communication, particularly amid the challenges posed by the COVID-19 pandemic. In vascular surgery, the adoption of postoperative virtual visits has proved to be a safe, cost-effective, and efficient means of monitoring patient recovery while minimizing the need for in-person clinic appointments. But despite its potential benefits, the use of virtual postoperative visits remains suboptimal, prompting the creation of a quality improvement initiative aimed at enhancing their use.

Background and local problem: Virtual postoperative visits play a crucial role in timely identification of complications such as wound infection, hematoma, or graft failure in vascular surgery patients. Yet even as the pandemic necessitated a shift towards virtual care, the rate of postoperative virtual visits in a cancer center remained steady at around 30%. Recognizing this as a local problem, efforts were directed towards increasing the utilization of virtual postoperative visits through targeted interventions.

Methods and interventions: The quality improvement initiative encompassed several key interventions within the discharge process: a) implementation of scheduled virtual visits post-education and patient discussions pre-discharge; b) modification of the electronic health record to include smart phrases facilitating virtual visit education and built-in reminders for follow-up scheduling; c) adaptation of patient education materials to incorporate real-time demonstrations and keywords for virtual assessments; and d) staff training on virtual evaluation techniques for incisions and postoperative complications.

Results: Following the implementation of these interventions and iterative Plan-Do-Study-Act (PDSA) cycles, the rate of postoperative virtual visits surged to over 50% and was sustained. A sample of 49 patients revealed an impressive 87% completion rate for virtual visits within three weeks post-surgery. Additionally, associated benefits included a reduction in clinic no-show rates, 30-day readmission rates, and surgical site infections. Notably, the teach-back method emerged as an effective strategy for educating elderly patients on virtual visit technologies, underscoring the feasibility of virtual postoperative care among this demographic.

Conclusion: The successful enhancement of postoperative virtual visits in vascular surgery not only underscores the safety and feasibility of virtual care but also offers avenues for future research. From exploring the impact of nursing care and patient education to ensuring equitable access among older adults, virtual postoperative care stands as a promising frontier in enhancing patient outcomes and optimizing healthcare delivery.