How to effectively manage postoperative patients in rural hospitalist programs to improve patient outcomes and resource use

Effectively managing postoperative patients in any setting is essential—but it takes on a special urgency for rural organizations that face extra resourcing challenges and logistical obstacles. A strong post-op process can save time and dollars, improve patient safety and satisfaction, and ensure continuity of care throughout the encounter. In this blog post, we’ll dive deeper into why smooth post-op processes are so important for rural hospitals and unearth strategies for improving how your organization manages post-op patients.

7 reasons why you should focus on postoperative patient management

Investing in your postoperative patient management strategy should be at the top of your list. The resulting benefits are particularly salient for rural organizations that often struggle with staff retention, patient engagement, and financial sustainability:

  1. Quality of care: Effective management of postoperative patients ensures that they receive high-quality care, regardless of location. By providing appropriate follow-up care, careful monitoring, and support for any complications or concerns, healthcare providers can contribute to positive patient outcomes and minimize the risk of postoperative complications.
  2. Timely intervention: Prompt identification and treatment of postoperative complications are crucial for preventing escalation and ensuring timely intervention. In rural areas where access to specialized care may be limited, effective management of postoperative patients ensures healthcare providers recognize warning signs or complications early on and take appropriate action. This can prevent the need for emergency transfers or delays in receiving necessary care.
  3. Continuity of care: Reliable, consistent communication and care from start to finish are key to a successful operation and recovery process. Postoperatively, this includes coordinating with primary care providers, specialists, and other healthcare professionals involved in the patient’s care. By facilitating seamless transitions and maintaining open lines of collaboration, rural healthcare providers can contribute to the patient’s overall well-being, ease their experience, and optimize their recovery trajectory.

Case Study: By improving post-op care and collaboration with surgeons, Aligned Providers has passed the state survey with zero deficiencies. (In fact, we helped write policies for the state of Nebraska!) Our partner organizations were also able to keep patients within the 96-minute ALOS required for Critical Access Hospitals.

  1. Patient satisfaction and community trust: When patients feel engaged in their care, receive proper treatment (medical and interpersonal), and experience positive outcomes, they are more likely to have trust in the rural healthcare providers and to recommend the hospital to acquaintances with similar conditions. This can lead to improved patient-provider relationships, better community health engagement, and increased patient and caregiver satisfaction with the entire encounter.
  2. Patient safety: In a rural setting with limited access to immediate specialized care, providers must be fastidious about following patients after surgery. Postoperative patients are at increased risk of complications, such as infections, medication errors, or surgical site issues. Proper monitoring, timely intervention, and clear postoperative care instructions can help prevent adverse events and optimize patient safety.
  3. Resource optimization: By providing appropriate post-op care and preventing complications, healthcare providers can potentially reduce the need for emergency department visits, hospital readmissions, or transfers to distant facilities. This enables rural healthcare facilities to allocate their limited resources more efficiently, ensuring that clinicians are available for patients who truly require them.
  4. Cost-effectiveness: Excellent postoperative care helps patients avoid complications, reduces hospital readmissions, and minimizes the need for emergency transfers—all of which can significantly reduce healthcare costs. Additionally, patients whose post-op care is managed effectively locally may experience financial savings by avoiding unnecessary travel or prolonged hospital stays.

6 strategies for optimizing post-op care

Successfully managing postoperative patients in a rural setting is not without its challenges. When you start from a place of limited resources and people—as many rural hospitals do—it can be challenging to find an easy starting point. The following strategies help break down the improvement process into simple, straightforward steps.

  1. Clear communication and coordination: The surgical team, rural hospitalist program, primary care providers, and any specialists involved in the patient’s care should collaborate closely and communicate regularly to review the patient’s progress and align care plans. Timely sharing of information regarding the surgery, postoperative instructions, medications, and follow-up care is essential for a smooth transition and continuity of care.

Put it in action: Start listening to surgeons about patient needs. Trust their input on which patients need to stay overnight, what care best practices are, and who is best equipped to be on the care team.

  1. Comprehensive discharge planning: Develop a comprehensive discharge plan that includes detailed instructions for postoperative care, medication management, wound care, dietary recommendations, and any necessary lifestyle modifications. Discuss this information with the patient and their family members, ensuring they have a clear and complete understanding of directions for the recovery phase. Discharge planning can be a complex process, so start early and assign responsibilities strategically.

Put it in action: Try having hospitalists take point on completing history and physical and discharge summaries. By sharing administrative burden between surgeons and hospitalists, you can achieve better documentation and improved reimbursements.

  1. Education and empowerment: Educate patients and their families about the surgery, expected postoperative course, potential complications, and signs of trouble. Encourage them to ask questions and thoroughly address any concerns they may have and empower them to take an active role in their recovery by providing written materials, educational videos, and access to reliable online resources. Regularly check in with patients and their families to address any concerns, provide reassurance, and ensure their ongoing engagement in the recovery process.

Put it in action: Create a clear calendar showing patients and families when they should expect to hear from you, what symptoms to look for at specific times in recovery, when follow-up visits are happening, and when to schedule additional services.

  1. Home healthcare services: In a rural setting, patients may encounter additional obstacles to accessing prescribed postoperative care services. Consider arranging home healthcare services, if available, to provide additional support to patients during their recovery. Home healthcare professionals can assist with wound care, medication administration, physical therapy exercises, and monitoring the patient’s overall progress.

Put it in action: Discuss a patient’s anticipated challenges before they leave the hospital. Be proactive in understanding the patient’s typical schedule, transportation availability, and other important factors that could influence access to post-op services.

  1. Telemedicine and remote monitoring: Utilize telemedicine services to stay in close touch with post-op patients without requiring them to travel long distances. Remote monitoring capabilities allow healthcare providers to conduct virtual follow-up visits, assess incisions, and review symptoms. Remote monitoring devices can also be employed to track vital signs, such as heart rate, blood pressure, and oxygen levels, providing valuable data for monitoring the patient’s recovery.

Put it in action: For patients who require remote monitoring devices, make sure they receive comprehensive training on how to use the equipment at home. If possible, have patients and caregivers do a few supervised practice runs. 

  1. Local community support: Leverage local community resources, such as support groups, volunteer organizations, or community health centers, to provide additional assistance to postoperative patients. These resources can offer emotional support, transportation assistance, or help with activities of daily living, especially for patients who may not have strong personal support systems.

Put it in action: Build strong connections with community resource groups. Understand exactly what they offer and how they operate so you can knowledgeably recommend specific resources to your patients.

To summarize…

Postoperative care is a particularly important priority for rural hospitals right now.

A well-designed, well-executed postoperative process can help organizations positively influence:

  • quality and continuity of care
  • timeliness of interventions
  • patient satisfaction and safety,
  • and budget and resource utilization.

To support a successful post-op experience, providers must:

  • communicate clearly and collaborate closely
  • execute comprehensive discharge planning,
  • offer robust patient and caregiver education,
  • deliver alternative interface options (e.g., home health, telemedicine),
  • and connect their patients with reputable community support resources.

Have questions? We’d love to answer them. Have staffing and operations challenges? We’d love to help you solve them. Contact us to get started.