VIDEO INSTRUCTION VERSUS WRITTEN INSTRUCTION IN POSTOPERATIVE CARE OF

LAPAROSCOPIC CHOLECYSTECTOMY

INTRODUCTION:
Timely and accurate discharge communication regarding post-operative care instructions is important
in continuing patient care and to prevent post operative complications to some extent. [1]. The
discharge summary is the most common mode of communication of discharge instructions to the
patients. Effective discharge summaries reduce, unplanned hospital readmission, post-discharge
complications and mortality, and increase patient satisfaction [2, 3]. Delivery of discharge instructions
is often rushed and patients frequently do not understand aspects of their discharge, medication
management, possible non-serious complications and their management at home, especially when it
is necessary to visit to emergency and when not, This is chiefly in context of the fact around 50% of
our population is non-medical related and many of them are not even literate enough to read and
comprehend the instructions. Low health literacy, anxiety, cognitive impairment, or language barriers
might further limit patients’ ability to understand medical information shared at discharge, resulting
in treatment failures[4] Patients who have poor comprehension of discharge instructions may have
higher rates of emergency department visits, hospital readmissions [5]. Improving patients’
understanding is likely to improve health outcomes and avoid unnecessary healthcare utilization and
patient visits and resources and the effort of visiting emergency room, out patient departments ,long
travel visits, waiting in long lines for hours. Previous studies found that a clinically relevant proportion
of patients being discharged from hospitals are not able to recall their diagnoses and discharge
instructions.[6,7] Despite the importance of deliverance of post operative care instructions and
complications, this if often done is a hurry without making sure about the adequate comprehension of
patients and/or their care-givers. With the proliferation of technology and the ubiquitous presence of
the Internet and mobile media, more effective communication methods have become available to
help improve delivery of health education.[8-11] Today’s visual learner can be educated with the use
of graphics, animation, and videos. The aim of this review was to compare the patient satisfaction and
unnecessary visits concerning the means of provision of information/instructions to patients
discharged either from day care or inpatient services.[12-15] This study will be conducted among
patients undergoing laparoscopic cholecystectomy in day care or in patient services. Laparoscopic
cholecystectomy is considered as a gold-standard treatment for cholelithiasis all around the world
and is one of the most common procedure undertaken in our facility. Common post operative
complications after laparoscopic cholecystetcomy are port-siteminor infection, early adhesive
intestinal obstruction, bile leakage, biloma formation, bleeding by vascular injury, CBD injury.
This surgery will be conducted at Indus hospital, where we have five competent operative surgeons,
patient compliance to the instructions, Literacy level and understanding of surgery and its pre and
post operative instructions will be taken into consideration.

OBJECTIVES:
Will Video instruction help in post-operative course/complications, patient satisfaction and
understanding after laparoscopic cholecystetcomy.

HYPOTHESIS:
Usage of video can improve understanding of patients regarding post-operative care and instructions
as compared to verbally explained or written instructions in discharge summaries.

STUDY SELECTION:
Randomized clinical trials that randomized patients to receiving a discharge
communication through video to a control group were included.

SETTING:
Indus hospital, main branch, korangi, karachi.
SAMPLE SIZE:
Will be calculated later

SAMPLING TECHNIQUE:
Simple random sampling
SAMPLE SELECTION:

INCLUSION CRITERIA
- Patients undergoing laparoscopic cholecystectomy in day care as well as in patient.
- Age 30-70 years
- Uneventful surgery

EXCLUSION CRITERIA
- No prolong hospital stay due to any postoperative complications
- Co-morbids other than diabetes mellitus, hypertension
- Obese patients

DATA COLLECTION PROCEDUE:

- A proforma with close ended questions

DATA ANALYSIS PROCEDURE:

- SPSS

REFERENCES:

1. Chen Y, Brennan N, Magrabi F. Is email an effective method for hospital discharge communication?
A randomized controlled trial to examine delivery of computer-generated discharge summaries by
email, fax, post and patient hand delivery. Int J Med Inform 2010;79:167–72.
2. Kripalani S, LeFevre F, Phillips C et al. De ficits in communication and information transfer between
hospital based and primary care physicians: implications for patient safety and continuity of care.
JAMA 2007; 297:831–41.
3. Shepperd S, Parkes J, McClaran J et al. Discharge planning from hospital to home. Cochrane
Database Syst Rev 2004;1:1–3
4. Kessels RP. Patients’ memory for medical information.J R Soc Med. 2003;96(5):219-222.
5. Ziaeian B, Araujo K, Van Ness P et al. Medication reconciliation accuracy and patient understanding
of intended medication changes on hospital discharge. J Gen Intern Med 2012;27:1513–20.
6. Price JR, Mayou RA, Bass CM, Hames RJ, Sprigings D, Birkhead JS. Developing a rapid access chest
pain clinic: qualitative studies of patients’ needs and experiences.J Psychosom Res. 2005;59(4):237-
246. doi:10.1016/j. jpsychores.2005.04.004
7. Sanderson BK, Thompson J, Brown TM, Tucker MJ, Bittner V. Assessing patient recall of discharge
instructions for acute myocardial infarction.J Healthc Qual. 2009;31(6):25-33.
doi:10.1111/j.19451474.2009.00052.x
8. Baker L, Wagner TH, Singer S, et al. Use of the Internet and e-mail for health care information:
results from a national survey. JAMA. 2003;289:2400Y2406
9. Baur C. Using the Internet to move beyond the brochure and improve health literacy. In: JG
Schwartzberg, JB VanGeest, CC Wang, eds. Understanding Health Literacy: Implications for Medicine
and Public Health. Chicago, IL: AMA Press; 2005.
10. Cassell MM, Jackson C, Cheuvront B. Health communication on the Internet: an effective channel
for health behavior change? J Health Commun. 1998;3:71Y79.
11. Balasubramanian K, Thamizoli R, Umar A, et al. Using mobile phones to promote lifelong learning
among rural women in Southern India. Distance Education. 2010;31:193Y209.
12. Lawrence LM, Jenkins CA, Zhou C, et al. The effect of diagnosis-specific computerized discharge
instructions on 72-hour return visits to the pediatric emergency department. Pediatr Emerg Care.
2009;25:733Y738.
13. Delp C, Jones J. Communicating information to patients: the use of cartoon illustrations to
improve comprehension of instructions. Acad Emerg Med. 1996;3:264Y270.
14. Austin PE, Matlack R 2nd, Dunn KA, et al. Discharge instructions: do illustrations help our patients
understand them? Ann Emerg Med. 1995;25:317Y320.
15. Zeng-Treitler Q, Kim H, Hunter M. Improving patient comprehension and recall of discharge
instructions by supplementing free texts with pictographs. AMIA Annu Symp Proc. 2008;6:849Y853.
 Appendix 1

PROFORMA

NAME:
AGE:
OCCUPATION:
DATE OF SURGERY:
MODE OF ADMISSION:
MODE OF DISCHARGE:
CONSENT TO BE INCLUDED IN STUDY:

WERE YOU COUNSELLED PRE-OPERATIVELY?

DO YOU HAVE ANY MEDICAL RELATED FAMILY MEMBER OR FRIEND ?

DID YOU KNOW ABOUT THE SURGERY PRE-OPERATIVELY?

DID YOU UNDERSTAND THE DISCHARGE INSTRUCTIONS ?

WERE THEY EXPLAINED TO YOU ?

DID YOU UNDERSTAND WHAT MEDICATIONS TO TAKE IN CASE OF POST

OPERATIVE PAIN?

DID YOU KNOW WHAT ARE THE COMMON POST OPERATIVE

COMPLICATIONS ?

DID YOU KNOW WHEN TO VISIT ER ?

DID YOU KNOW WHEN AND WHY TO VISIT OPD ?

DID YOU FACE ANY DIFFICULTY AFTER BEING DISCHARGED THAT YOU
MANAGED AT HOME ?

DID YOU ASK ABOUT ALL YOUR QUERIES BEFORE DISCHARGE ?DID YOU
CONSULT ANY NEARBY CLINIC OR MEDICAL PERSONNEL FOR ANY OF
YOUR QUERY?

DID YOU VISIT ANY MEDICAL FACILITY OTHER THAN INDUS HOSPITAL POST
DISCHARGE ?

DID YOU FACE ANY DIFFICULTY AFTER BEING DISCHARGED ?