Topics

Tele-health

Overview and approach

Telehealth post-operative follow-up (scenario below: day-7 review after laparoscopic cholecystectomy without intra-operative cholangiogram). Aim: screen for complications (bile leak/duct injury, collection, infection, bleeding, retained stones, VTE) and decide whether the patient needs in-person assessment.

Assessment and clinical features

Structure: confirm identity/location/privacy and consent to a colleague listening; symptoms (fever, abdominal pain, N/V, jaundice, dark urine, pale stools, wound problems, bowel/urine changes, calf pain/SOB); medicines; lifestyle; patient-reported observations (HR, BP, temperature); wound inspection by video.

Differentials and investigations

Differentials: bile leak/biloma, bile duct injury or retained stone (jaundice, cholangitis), wound infection, port-site haematoma, post-op ileus, DVT/PE. Investigations are not available by video: arrange bloods (FBC, CRP, LFTs), ultrasound, and consider MRCP/ERCP via the treating surgeon.

Scenario

Your next patient in the ESU Follow-Up Clinic (LGH) is Kim Novak, who last week had a laparoscopic cholecystectomy for acute cholecystitis at the LGH. The consultation will be via tele-health videoconferencing. The operation note states that the “critical view was obtained, but IOC could not be performed due to a short cystic duct… no drain was inserted”.  She was discharged to the following morning.

Kim lives in Scamander on the East Coast of Tasmania

Scenario Student Tasks

  • Assess the patient. How would you do this on telehealth?
  • Suggest a management plan as required,
  • Respond to any concerns the patient may have
    • An intraoperative cholangiogram (IOC) is an X-ray
       of your bile ducts. It’s usually done during surgery to remove your gall bladder
    • Having a view of your bile duct during surgery involving your gallbladder helps your surgeon check for gallstones and avoid damaging your bile duct.
Notes

Proforma

  1. Introduction
  2. Confirm pt
    1. Name
    2. age
    3. address
    4. Quiet private place appropriate to talk, alone
    5. Colleague with me listening in, is that alright with you
    6. Are we good to begin + confidentiality
  3. Recently had the operation, how did that go?
  4. Usually we like to do an x-ray of your bile ducts during the surgery but we couldn’t in your case due to the short ducts so we would like to ask some questions to rule out any complications post surgery
  5. How are you feeling today?
  6. What symptoms are you experiencing?
    1. nausea and vomiting, indigestion, changes to bowel habits
    2. signs of infection at wound site (increasing pain, swelling or redness, and pus leaking from a wound)
    3. bleeding from the wound site
    4. Signs of bile leakage( abdominal pain, N+V, fever, swelling)
    5. signs of obstruction
    6. signs of peritonism (tender and distention, decreased urine, no bowel movements, thirst, fever, N+V,
    7. signs of organ perforation (blood in stools, changes to urination)
    8. DVT (calf tenderness, SOB)
  7. Have you been taking your medications as prescribed? SE?
  8. Medical conditions
    1. Are you experiencing any stress or anxiety related to your condition?
  9. Allergies
  10. Have you been following any recommended lifestyle changes?
    1. Been getting help with things around the house
    2. Time off work
    3. diet
    4. smoking
    5. alcohol
    6. recreational drug
  11. O/E
    1. Have you been monitoring your vitals? (blood pressure, blood sugar, etc.)
      1. HR
      2. BP
      3. Temp
    2. Dressing: keeping wound site dry
    3. Wound site: signs of infection

    4.

  12. Recommendations
    1. I think this is a medical emergency and require medical intervention. Are you able to call 000 and go to the nearest hospital which I think is at St Helen’s district
    2. I think this is a medical emergency and require medical intervention before it worsens. Are you able to call 000 and go to the nearest hospital which I think is at St Helen’s district. If you are stable by the time you get to the hospital they might even consider bringing you to LGH.
    3. US? at Gp or district hospital
    4. Abx if infection - at St Helen’s district hospital if IV
    5. Re-dressing?
    6. Re-operate for leakage, injury to bild duct
  13. CRISF
    1. Do you have any questions or concerns about your treatment plan?
    2. Is there anything else you would like to discuss or address during this appointment? repeat scripts?
    3. Thank you for your time, I’ll see you in a couple of weeks

NAME

Management and follow-up
  • Well and wound clean: routine surgical follow-up, activity/diet advice, return precautions.
  • Concerning symptoms: arrange in-person assessment the same day (nearest ED); if unstable, call 000. For a rural patient (Scamander), nearest hospital is St Helens District Hospital, with transfer to LGH if needed.
  • Close the consultation with a summary, questions, scripts and follow-up.
Red flags and clinical pearls
  • Fever with jaundice or RUQ pain, persistent vomiting, peritonism, rising abdominal distension: urgent in-person care.
  • Telehealth limits examination: low threshold for face-to-face review.
  • Confirm contact details and a fallback plan if the video drops.

Last updated from Sen’s notes on 9 October 2026.