Post-operative visits to the emergency department are fairly common with just over 15 per cent of patients going to a hospital emergency department within six weeks after any type of surgery, a B.C. study shows.
The most frequent complaints and diagnoses were surgery-related pain, infections, and bleeding, according to the cover-featured study published in the B.C. Medical Journal.
Study co-author Dr. Susan McDonald said that since more and more patients are released the same day as their operations, patients are losing close attention and education from nurses. That loss in post-operative oversight has increased the likelihood that patients will experience concerns or complications after they’ve been discharged.
McDonald, a general surgeon at Chilliwack General Hospital, said some surgeons tell patients to come back for follow-ups two to three weeks after their operation, while others stipulate six weeks; often it has to do with the complexity of the procedure. But patients often feel they can’t wait that long when problems arise.
The finding that 15.1 per cent of surgery patients are rushing to the emergency department within weeks following surgery suggests there are quality improvement measures required, McDonald said. She’s urged the Fraser Health Authority, for example, to immediately notify surgeons when one of their patients has returned to the hospital. But she said the health authority has to find a workaround to alter the way computerized hospital records are formatted so that surgeons can receive such notifications whenever one of their patients has a post-operative problem.
“As a surgeon, I want to be alerted about patients who have complications. I can’t fix anything I don’t know about,” McDonald said. “Surgeons need this information as well for their own personal learning. It’s disheartening when patients develop infections. They lose faith in their doctors and in the system.”
She said patients also need to ask more questions, be given more information as part of their informed consent process, and be urged to read and retain the handout brochures they are given so they know what to expect after surgery.
The study was based on the charts — marked for the study purposes with a red dot — of about 250 post-operative patients who went to the Chilliwack hospital in the summer of 2015.
Of the total, just over half had their surgery at that hospital while the rest had their operations in other hospitals. Only two patients who went to the ER required admission to hospital while the rest were prescribed antibiotics, other medications, or some form of treatment and then released.
McDonald said while the study was done on patients who went to the Chilliwack hospital, she believes the results can be applied more generally.
“There are not a lot of studies that have been published that look at things from this approach. Most studies look at either specific diseases or procedures and then look back retrospectively to determine the rate of emergency room visits. But I believe we were very close to the numbers quoted in those other few studies.”
The takeaway message for patients and doctors is that communication is critically important, she said. Anticipated or even unexpected issues should be covered during consultations with surgeons. Patients should know what to expect, including how much pain and discomfort may be expected since all surgery does involve some pain. Patients should also have discussions with doctors about who to see or where to go if they have problems so that emergency departments aren’t necessarily the default destination for visits that aren’t true emergencies.
But McDonald admits it’s also likely that the growing number of patients without primary care physicians is contributing to a high number of patients using ERs.
“Up to 30 per cent of patients in Chilliwack don’t have a family doctor. This is definitely something on my radar now and may be a strong factor in why people are going to the ER.”
McDonald said while an ideal scenario would involve emergency doctors calling surgeons when their patients attend the ER, she knows they are usually far too busy to do that, not to mention reluctant to call surgeons late at night or on weekends.
“Emergency doctors are awesome, they’re doing their best, but they are overworked. Still, this is an issue about the need for better communication so no one should be afraid to pick up the phone or notify surgeons who may want to know what the problem is and how to rectify it.”
McDonald said further research is taking a deeper dive into the data.
A few months ago, another B.C. study showed that this province has the second highest hospital readmission rate in the country. Hospital readmission rates are a marker of health system performance and add substantial costs to hospitals.
The national average for urgent, unplanned readmissions for medical problems like mental health issues, cancer, heart failure, and chronic obstructive pulmonary disease is 9.1 per cent. But the B.C. rate is 9.6 per cent while Saskatchewan has the highest rate — at 9.9 per cent.