Photographic Email Correspondence for Pediatric Urology Post-Operative Patients
Photographic Email Correspondence for Pediatric Urology Post-Operative Patients
A pilot research study is planned to occur within the pediatric urology service the spring of
 2015. All pediatric urology patients in the immediate post-operative period of 0-14 days will
 be eligible for this study. This study will compare the current standard of care for managing
 post-operative complications (a telephone conversation with the NP) versus an experimental
 intervention (telephone call and an electronic photograph of the surgical site). Before the
 surgical patient is discharged from the hospital, consent will be obtained for participation.
 Once a family initiates contact with the NP with a post-operative concern they will be
 randomized to either the control or the experimental group. Those in the control group will
 receive the current standard of care, which is telephone advice only. Those in the
 experimental group will speak to the NP on the telephone and will be requested to send an
 electronic photograph of their child's surgical site to the NP for assessment and advice.
 Photographs will be assessed using a standardized tool by both NPs and this information will
 be entered into a database. The investigators will be measuring the number of emergency
 department (ED) and/or unplanned clinic visits in both groups. An unplanned clinic visit is
 defined as a visit that is required due to an unexpected complication or concern before the
 original scheduled post-operative follow-up as determined by the surgeon. The investigators
 will be tracking the number of follow-up phone calls for both groups, as well as requiring
 participants to complete a family/patient experience survey after speaking to the NP.
This study design will be a pilot randomized controlled trial. Consent for this study will be
 obtained within the circle of care immediately before the patient is discharged home
 following surgery. The families will be instructed to contact the NP by telephone with any
 post-operative questions or concerns they have about their child. Once the family initiates
 contact with the NP, they will be randomized into either the experimental (PEC) group or the
 control (TTC) group.

 Once randomization has occurred, the NP will obtain all necessary information from the parent
 by addressing all points in expertise based script developed by the Pediatric Urology Team
 for both groups. Those randomized to the control group (TTC) will be provided recommendations
 based on information obtained during the standard telephone call. Families who are randomized
 into the PEC (experimental) group will be required to send a digital photograph of the
 child's surgical site to the professional email address of NP. Should they agree to send
 digital photographs they will be required to give consent for email correspondence, which
 will be emailed to them by the NP. Once they have consented they may send digital photographs
 to the NP of their child's surgical site, which will be assessed by both NPs using an
 expertise-based assessment tool. This information will be entered into REDCap. The NPs will
 come to a unanimous decision regarding advice to be provided and this will be communicated to
 the parents. Upon completion of the interaction with the NP the RA will contact the family to
 complete the family/patient experience survey over the telephone. Family/patient experience
 will be measured using an adapted validated tool "Nurse Practitioner Satisfaction Survey"
 consisting of 10 questions directly related to telephone interaction with the NP. This survey
 consists of a Likert Scale with scores ranging from 1-5 with 5 being the most positive
 response. Follow up telephone calls for both groups will be logged in MediTech as well as the
 RedCAP database. All telephone calls will be documented within the MediTech system and
 included in patient's chart in order to maintain current standard of care. All digital photos
 will be printed and placed in the patient's chart and deleted from the email server, which is
 the current process for those engaging in PEC.

 Recruitment for this study will occur for 7 months with the aim of recruiting 40 patients per
 arm in order to obtain the feasibility data. However, a sample size calculation has been
 carried out and assuming 75% power and an alpha error of 5% using a one sided test, the
 required sample size to answer the definitive research question is 114 patients per group.

 Data will be analyzed by comparing the number of ED and unplanned clinic visits for both
 groups, as well as the number of follow up phone calls received. This will be done using
 descriptive statistics and a t-test for independent means. Family/patient experience will
 also be measured between the two groups (PEC and TTC) using descriptive statistics and a
 t-test for independent means. Subgroup analysis will be done to determine which subgroup of
 post-operative patients benefit most from PEC (i.e., penile surgeries).
Inclusion Criteria:

 -  Children aged 0-17 years who have undergone urological surgery.

 -  Children within the immediate post-operative period (0-14 days).

 -  Children with concerns directly related to operative site including, but not limited
 to catheters, stents, rashes and urine output.

 Exclusion Criteria:

 -  Surgical patients outside the immediate post-operative period.

 -  Those families who are unwilling or unable to email digital photographs.

 -  Concerns related to issues other than the operative site (medications, follow up
 appointments, return to activities).

 -  Inability to understand written consent due to language barrier