States are beginning to reopen, and more healthcare systems and hospitals are allowing elective surgeries and nonessential procedures. As we move into a post-COVID-19 environment, how can providers continue using virtual care in these procedures?

In mid-March, the Centers for Disease Control and Prevention (CDC) recommended that hospitals and outpatient surgery centers halt all adult elective surgeries and nonessential medical, surgical and dental procedures during COVID-19. During this time, many healthcare providers turned to virtual health and telehealth technologies—such as web chats, videoconferencing platforms and more—to continue to monitor and treat patients with chronic medical conditions or non-urgent issues. Now, as states reopen and hospitals, healthcare systems and outpatient surgery centers resume elective and nonessential procedures, many are looking to utilize virtual care delivery in preoperative and postoperative care.

Although COVID-19 shined a light on the benefits of telehealth, it’s not a new concept, explains Noreen Stauffer, senior director of clinical consulting at Medecision.

In 2013, the U.S. Department of Veterans Affairs (VA) healthcare system conducted a pilot program investigating whether a telephone visit could take the place of a traditional office visit for postoperative care in elective general surgery cases. The study took place over 10 months, and during that time, the VA experienced excellent clinical outcomes and high patient satisfaction reports. Since that program, other studies have been conducted in surgical fields such as urology, plastic surgery, neurosurgery, and obstetrics and gynecology.

So, how can virtual health technology be used in a surgical environment? Here are a few suggestions from Stauffer and Cate Higgins, senior clinical consultant at Medecision.

> Patient education. Patients typically receive education about a disease, treatment or upcoming procedure during a face-to-face interaction with their healthcare provider. But with virtual care, providers can share educational videos, link to other trusted resources and provide a wealth of information, Higgins says. Virtually delivered patient education is effective, too. In a 2018 systematic review of 16 studies between 2006 and 2017, researchers found that virtual education “delivered to patients with chronic diseases was comparable, or more effective, than usual care.” Although more research is still needed to determine the effectiveness of virtually delivered education for surgical procedures, one can reason that telehealth is a useful tool in communicating with patients about their condition or upcoming treatment.

> Preoperative evaluations. If a patient is scheduled for a joint replacement, the physician may want to know of any hazards in the home. “Typically before a surgery or procedure, a nurse will call a few days prior to review the patient’s medical history, answer questions and discuss any concerns,” Higgins says.

“If this conversation can be done via videoconferencing, then the nurse can evaluate how cluttered a patient’s house is, how many stairs they may have or any other type of hazards in the home,” Stauffer adds. “This isn’t to be nosy, but instead to make sure that the patient is returning to a safe place and avoiding future injuries. It’s done in the spirit of decreasing readmissions.”

> Postoperative care. Virtual care delivery has been used in three ways during the postoperative period: follow-up visits, routine monitoring, and management of new conditions or issues as needed. In a 2018 article published in mHealth about the role of telemedicine in postoperative care, the authors wrote that there are “excellent clinical outcomes following the introduction of telemedicine in the postoperative setting. Studies report that clinical outcomes are comparable to the outcomes in the setting of traditional clinic follow-up.” Although virtual health was already being utilized in postoperative care prior to COVID-19, we’ll start seeing it even more as we move to a post-COVID-19 environment, Higgins suggests.

“I think we’re going to see that much of these follow-up visits can be done quicker and more efficiently through virtual care,” she adds.

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