Background: In outpatient hypospadias surgery, typical vs. abnormal postoperative recovery patterns are not readily recognizable by patient’s caregivers. This can lead to caregiver concerns and anxiety that can influence postoperative experiences, leading to unanticipated health care utilization. Specifically, postoperative phone calls may be a marker of this caregiver anxiety and place a substantial burden on the health care system. The primary objective of this quality improvement study was to identify and characterize postoperative hypospadias patient’s caregiver phone calls in order to identify areas for improved patient care. The secondary objective was to implement specific interventions to reduce avoidable phone calls. Methods: We utilized data from the National Surgical Quality Improvement Program Pediatric (NSQIPP) over the most recent 5 years (7/1/2018-6/30/23) to identify patients that underwent hypospadias repair at a free standing children’s hospital. All primary and revision hypospadias procedures were included. Only cases performed by attending surgeons currently at the institution were included. NSQIPP data were supplemented by individual chart review, evaluating phone calls made within 30 days postoperatively. Reason for calls were categorized according to the caregiver’s concerns, as documented by the nurse or physician taking the phone call. The outcome of each phone call was also categorized. An intervention aimed at the most common reason for phone calls was then created and implemented. After the intervention implementation, data was then collected prospectively on all hypospadias patients through a prospective quality improvement database. Results: In the last 5 years, 52% (32/62) of hypospadias patient’s caregivers at our intuition called postoperatively with concerns. The most common reasons for phone calls were pain (20/79; 25%) and wound concerns (15/79; 19%). The majority of pain phone calls (65%) and wound concern phone calls (87%) only required reassurance. Data is summarized in Table 1. We identified inconsistencies in postoperative prescriptions and poor caregiver knowledge as targets for intervention. We then developed two new postoperative discharge order sets focused on standardized medication orders and detailed discharge education on pain expectations/management and wound appearance for the caregivers. This latter order set provided specific scenarios in which to call for guidance. Surgeons underwent education and were provided support for order set utilization. After 4 months post-intervention, there were zero calls about pain (0/18; 0%) and only two wound concern calls (2/18; 11%), one of which met criteria on discharge instructions to call. Order set utilization was 100% for discharge education and 75% for medications. Conclusion: Most hypospadias caregivers call postoperatively with pain and wound concerns, which generally only require further education and reassurance. Creating standardized order sets for postoperative prescriptions and discharge education can decrease unnecessary postoperative phone calls significantly.
| Pre-Intervention | Post-Intervention | |
| Total number of hypospadias patients | 62 | 20 |
| Emergency Department visits | 2/62 (3%) | 0/20 (0%) |
| Patients who called | 32/62 (52%) | 11/20 (55%) |
| Patients who called multiple times | 16/32 (50%) | 5/11 (45%) |
| Type of repair | ||
| Distal | 14/32 (44%) | 6/11(55%) |
| Proximal | 11/32 (34%) | 3/11 (27%) |
| Complication/redo | 7/32 (22%) | 2/11 (18%) |
| Additional anesthesia | ||
| Caudal | 15/32 (47%) | 6/11 (55%) |
| Local | 17/32 (53%) | 5/11 (45%) |
| Needs Interpreter | 1/32 (3%) | 0/11 (0%) |
| Total phone calls | 57 (1.8 calls/patient) | 17 (1.5 calls/patient) |
| Reasons for phone calls | 79 reasons total | 18 reasons total |
| Pain | 20/79 (25%) | 0/18 (0%) |
| Wound concerns | 15/79 (19%) | 2/18 (11%) |
| Dressing concerns | 9/79 (11%) | 3/18 (17%) |
| Catheter issues | 9/79 (11%) | 4/18 (22%) |
| Voiding issues | 8/79 (10%) | 1/18 (6%) |
| Medication questions | 8/79 (10%) | 0/18 (0%) |
| Constipation | 6/79 (8%) | 1/18 (6%) |
| Fever/vomiting | 2/79 (3%) | 3/18 (17%) |
| Visible suture | 1/79 (1%) | 3/18 (17%) |
| Other | 1/79 (1%) | 1/18 (6%) |
| Outcomes of pain-related phone calls | ||
| Reassurance | 13/20 (65%) | N/A |
| Add new medication | 2/20 (10%) | N/A |
| Increase dose/refill medication | 3/20 (15%) | N/A |
| Clinic visit | 1/20 (5%) | N/A |
| New pharmacy | 1/20 (5%) | N/A |
| Outcomes of wound-related phone calls | ||
| Reassurance | 13/15 (87%) | 1/2 (50%) |
| Antibiotics given | 2/15 (13%) | 0/18 (0%) |
| At-home intervention | 0/15 (0%) | 1/2 (50%) |
| Order set utilization (discharge instructions) | N/A | 20/20 (100%) |
| Order set utilization (medications) | N/A | 15/20 (75%) |
| Met criteria to call on new discharge instructions | N/A | 6/17 (35%) |
