Implementing a Symptom Management Log to Improve Post-Operative Cystectomy Outcomes

Purpose: Radical cystectomy is an invasive, life-altering procedure that presents significant challenges in a patient recovery. Length of stay for these procedures has decreased with enhanced recovery after surgery programs resulting in a greater proportion of recovery at home. The primary goals of this project are to empower patients with greater autonomy, enhance their perception of preparedness for self-care following their surgical procedures, and reduce 30-day readmission rates.
Description: We developed a daily symptom management log for patients to track their temperature, incision appearance, pain level, fluid intake, urine output, ambulation, and bowel movements.
At the patient’s preoperative visit, the clinic RN provides standard procedure education along with a focus on early recognition of potential complications and use of the symptom management log when discharged home.
To ensure comfort with completing the log, the patient/caregiver practices use during their hospital stay and the inpatient RN reviews. On the day of discharge, a picture of the incision is taken and uploaded into the patient electronic medical record. Standard discharge instructions and copies of the log are sent home with patient. Appointments are scheduled for an NVO (nurse visit only) virtual appointment with a GU clinic nurse 2-3 days post-discharge to review the symptom log and patient education needs and answer questions of the patient/caregiver. The patient’s incision is viewed by the nurse via the video call or photo uploaded by the patient. The patient is encouraged to continue utilizing the log until their clinic visit which is scheduled within 14 days of discharge. Patient completes a 4-question survey (Likert scale and free answer) at their post-op visit regarding preparedness to care for themselves at home after surgery.
Evaluation: Patients are empowered to be more involved and diligent with monitoring and reporting of symptoms and concerns in the post-op setting from home. The interventions show improvement in care at home and increased patient awareness to care for self after cystectomy. A decrease is seen in incidence of 30-day readmission and readmission length-of-stay.