GYNOTEL: telephone advice to gynaecological surgical patients after discharge

Aims and objectives. To investigate in surgical gynaecological patients the types of health problems arising or persisting up to six weeks after discharge and the effectiveness of telephone advice. Background. The decreasing length of hospital stay has increased the need for specific instructions about the postdischarge period. Telephone advice could be a valuable tool to address this problem. To our knowledge, postdischarge health problems and the value of telephone advice have not been investigated among gynaecological patients. Design. Randomised controlled trial. Methods. Gynaecological patients expected to stay in the ward longer than 24 hour were invited to participate. A pilot study showed that wound healing, pain, mobility, urination, defecation and vaginal bleeding were the most common health problems postdischarge. Based on that information, guidelines were formulated that were used by trained nurses to give telephone advice to the intervention group (n = 235), in addition to the usual care. The control group of gynaecological patients (n = 233) received usual care only. Results. Of all 468 participants, about 50% were operated for general gynaecology. At discharge, wound pain (56%), mobility problems (54%) and constipation (27%) were the most frequently mentioned problems in both groups. Participants who completely followed the advice with regard to wound healing (p = 0·02), pain (p = 0·01), vaginal bleeding (p = 0·03) and mobility (p = 0·04) experienced greater improvement than participants who did not follow, or only partly followed, the advice. Conclusions. The telephone advice appears to make a significant contribution to help gynaecological surgical patients to solve or reduce their postdischarge health problems. Relevance to clinical practice. The positive effect of such advice can be interpreted as an improvement in the quality of life of the postoperative gynaecological patient.