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. 2023 Sep;226(3):324-329.
doi: 10.1016/j.amjsurg.2023.03.027. Epub 2023 Mar 29.

Preoperative history and physical update visits offer limited clinical value in colorectal surgery

Jacqueline M Soegaard Ballester  1 , Sara P Ginzberg  2 , Jacob Stein  3 , Heather Wachtel  4 , Najjia N Mahmoud  5
Affiliations

Preoperative history and physical update visits offer limited clinical value in colorectal surgery

Jacqueline M Soegaard Ballester et al. Am J Surg. 2023 Sep.

Abstract

Background: United States regulations require a history and physical (H&P) ≤30 days before planned procedures. We evaluated the impact of H&P update visits in colorectal surgery.

Methods: Preoperative H&P update visits conducted in colorectal clinics at our institution during 2019 were identified. Two independent reviewers assessed whether update visits identified interval changes to history, exam, or operative plan. Secondary outcomes included visit times, estimated travel times and distances.

Results: For 132 visits, interval changes were identified in 39% of histories, but only 4.2% of exams and 6.8% of operative plans. When plans changed, visit goals could have been accomplished via telehealth in 77.8%. Median clinic and round-trip driving time were 61.5 and 62.2 min, respectively.

Conclusions: H&P update visits conducted to satisfy the 30-day regulation rarely result in clinically relevant changes yet impose time and travel burdens on patients. Regulations should be revised to provide flexibility in H&P update modalities.

Keywords: High-value care; History and physical; History and physical updates; Regulations; Telehealth.

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Conflict of interest statement

This work and/or these authors were supported by the National Institutes of Health [grant numbers: T32CA251063-02 to JSB and KL2-TR001879 to HW] and by an institutional grant, the “Penn Medicine Gastrointestinal Oncology Transformational Grant.” The authors declare that they have no financial conflict of interest with respect to this study.

Figures

Figure 1.
Figure 1.. Selection of study cohort for chart review.
Abbreviations: history and physical (H&P).
See this image and copyright information in PMC

Comment in

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