3228 POET: A perioperative educational tool as an adjunct to enhanced recovery after surgery in patients undergoing minimally invasive gynecologic oncology surgery
Authors: Wang Bing Mei , Parrott Jocelyn , Brunger Jennifer , Beggs Pauline , Chapman Jocelyn 
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: The goal of this study was to determine the impact of an RN-guided preoperative educational intervention in a minimally invasive gynecologic oncology surgery cohort. Our specific objectives include: 1. To assess the impact of preoperative education on quality outcomes such as length of stay and discharge by noon rates. 2. To characterize the differential burden of post-operative communications on nursing staff in patients who received education versus those who did not. METHODS/STUDY POPULATION: This was a retrospective cohort study. We identified thirteen gynecologic oncology patients scheduled for minimally invasive surgeries (laparoscopic and robot-assisted) between March 2017 and July 2017. These patients served as the pilot for a quality improvement project comprised of a preoperative teaching session by a gynecologic oncology registered nurse (RN). Patients also received an educational booklet, designed by gynecologic oncology care team members including nurses and physicians. Educational topics included expectations for pre-, intra-, and post-operation; guidelines for post-op care at home, important contact information, and postoperative medication instructions. Patients were also given a prescription for their post-operative medications and asked to fill them before their surgeries. Following their surgeries, patients were asked to take a voluntary and anonymous 8-item online survey assessing their satisfaction with the educational intervention, their procedure, and their hospital stay. We matched these patients in a one-to-two ratio, to patients not included in the pilot, on the basis of surgery type and age. All subjects and controls spoke English as their primary language. We abstracted data from the electronic medical record including pathologic diagnosis, number of postoperative communications (telephone and email), content of postoperative communications, and various clinical characteristics. Outcome measures include length-of-stay, discharge-by-noon rate, percentage of patients with postoperative questions, and number of postoperative concerns communicated via telephone or email. RESULTS/ANTICIPATED RESULTS: There were 39 patients in the final cohort; thirteen of whom who participated in the pilot project, POET (Perioperative Educational Tool). Thirty-nine percent of POET patients had questions regarding their surgery or post-op care as compared with 61.5% of controls (P = 0.087). Nineteen percent of controls had questions about their postoperative medications, compared with zero percent of POET patients (P = 0.046). POET patients had an average of 0.69 postoperative communications, compared with 1.12 in controls. The length of stay was 8 hours in POET patients and 26 hours in controls (P = 0.317). The discharge before noon rate was 20% in POET patients and 25% in controls (P = 0.41). Of the 10 POET patients who completed the anonymous online survey, 100% liked the approach to teaching; 100% felt that they received consistent information regarding surgery, hospital stay, and post-op care, 100% felt prepared at discharge, 100% picked up their postoperative medications without difficulty prior to surgery. DISCUSSION/SIGNIFICANCE OF IMPACT: Patients uniformly had a positive response to their preoperative education. Although our primary outcomes were not statistically significant, the results of this unpowered, observational study suggest that anticipatory education such as we provided, may decrease the burden of post-operative communications related to surgical expectations. A preoperative teaching intervention may be especially valuable in educating patients about their postoperative medications. Although POET patients had significantly fewer questions about their postoperative medications, refilling their medications before their procedures did not seem to have an effect on discharge-by-noon rates. This may demonstrate that delays in disposition are not influenced by post-operative prescriptions. One limitation of our study is that we did not prospectively measure patient satisfaction with surgical care. Another limitation is that the pilot educational intervention was conducted entirely in English. To our knowledge, there exists no analysis of the effect of English language proficiency on outcomes such as patient satisfaction, length of stay, and discharge-by-noon rates, and other clinical outcomes in this surgical patient population. It is well-demonstrated in the literature that limited English proficiency contributes negatively to health care quality. Our next steps involve establishing a prospective study to measure the effects of preoperative education on patient satisfaction with their procedure, post-operative communications, and discharge by noon rates. We also plan to administer POET to Spanish- and Chinese-language speakers, to better understand the effect of limited English proficiency on our outcome measures of interest.