BACKGROUND:

Rising Relevance of Microsurgical Flaps in Limb Reconstruction: 

- Managing complex extremity defects of various etiologies, offering limb salvage, functional restoration, and aesthetic benefits.

- Valuable alternative to other treatment options, such as amputation, despite the presence of certain risk factors.

- 5-year survival rate is significantly higher in patients who received flaps compared to the amputated patients.

 

High Stakes in Postoperative Monitoring: 

- Vascular compromise remains a critical threat to flap viability, necessitating close, standardized monitoring.

- Effective interdisciplinary communication and patient involvement are crucial for optimal outcomes.

 

METHODS: 

Design: Prospective randomized unblinded controlled study at BIDMC (May 2022 - Jan 2025)

- Adult patients (≥18 years) who underwent upper or lower extremity reconstruction using a free or pedicled flap requiring inpatient postop monitoring.

Participants: 40 patients, either randomized to control (n=20, no video) or intervention (n=20, video)

Intervention: brief individualized video (<3 min)

- Recorded postoperatively by the surgeon, highlighting indications for surgery and important aspects of postop care; available to the care team via secure iPads, with optional patient viewing.

Data Collection: 12-item quality of care questionnaire utilizing a Likert scale was administered to providers and patients before discharge.

- Assessing communication clarity, care coordination, perceived stress and satisfaction.

 

RESULTS: 

Quality of Care Scores: Both patients and providers in the video group reported significantly higher ratings (Patients: 4.7 vs. 3.7; Providers: 4.1 vs. 3.6; p < 0.001).

Correlation: 

- Strong correlation between provider confidence and patient satisfaction (p = 0.62).

- No significant difference based on whether patients watched their own video and those who did not in the video group (p = 0.337).

- Watched video (n=9): 4.8

- Did not watch video (n=11): 4.7

 

CONCLUSION:

Improved Care Quality: Video-based sign-out enhanced patient and provider-rated communication and care.

Higher Provider Confidence: Strong correlation between provider confidence and patient satisfaction.

Standardization Benefits: Improved handoffs, reduced errors, and better support for junior staff. 

Patient Impact: Greater clarity, lower stress, and higher satisfaction with postoperative care.

 

Food for thought: 

Could standardized video sign-outs become a cost-effective, scalable adjunct to improve surgical outcomes across healthcare systems?

Can personalized video tools reduce provider burnout and improve long-term team performance in high-stakes surgical care?

Title: The Impact Of Educating Floor Nurses Through The Use Of Individualized Explanatory Videos On Limb Reconstruction Patient Aftercare - Preliminary Results On Satisfaction Of Patients And Providers