Navigational Focus on the Postoperative Touchpoint for Complex GI Patients

Background: A “touchpoint” can be defined as “a point of contact or interaction,” “a point of reference,” and as “a time, condition or circumstance that is vulnerable or unstable enough to precipitate a highly unfavorable, possibly devastating outcome.”¹

Objective: To evaluate the findings of the postoperative touchpoint in the complex gastrointestinal and hepatobiliary population seen by 2 Sarah Cannon nurse navigators.

Methods: Retrospective data from June 2018 to June 2019 were gathered on all patients who received a postoperative touchpoint call from their nurse navigator. A detailed list of the patient concerns as well as the navigator’s intervention was collected.

Results: INavigate records were reviewed on 63 patients who received postoperative touchpoint calls from a nurse navigator from June 2018-June 2019. Of 63 patients with documented calls, 26 required immediate intervention by the nurse navigator to avoid or mitigate postoperative complications. The following issues were discovered by nurse navigators during the postoperative touchpoint:

• Patient did not know whom to call after hours and on weekends for problems or concerns
• Fever
• Constipation
• Vomiting
• Diarrhea
• Infection
• Unusual drainage
• Dyspnea
• New onset/type of pain
• Abdominal pain
• Poor appetite
• Incorrect use of pain medication
• Esophageal leak with presenting symptom of cough
• No postoperative follow-up appointment scheduled
• Discharged without postoperative medications
• Assistance with diet
• Patient with home chest tube required admission for esophageal leak
• Durable medical equipment acquisition

Conclusions: Shorter hospital stays and decreased recovery times mean that patients return home while still early in the process of postoperative recovery. Discharge after a surgical procedure is a time of multiple instructions from providers and nursing staff accompanied by a significant quantity of written postoperative paperwork. Although personalized time is spent by nursing staff and providers on the day of discharge, the postoperative touchpoint is a vital reinforcement of the patient’s comprehension and assimilation of discharge instructions.

Reference

1. Touchpoint. Lexico. https://en.oxforddictionaries.com/definition/touchpoint.