Select hospitals in Ontario, Alberta adopt post-operative virtual monitoring

Patients recovering from cancer surgery and other surgeries are being sent home with technology that allows physicians and nursing staff to monitor them virtually. The program is happening at select hospitals in Ontario and Alberta as a continuation of a clinical trial that recruited more than 900 patients. The results from the clinical trial, called PVC-RAM, have been submitted for publication and are currently being peer-reviewed, but the impact of the program has been especially important during COVID-19, researchers report. Throughout the COVID-19 pandemic, physicians saw very high rates of patients returning to the emergency room or getting readmitted to hospital, said Dr. P.J. Devereaux, co-principal investigator and a cardiologist at Hamilton Health Sciences and a professor at McMaster University. He said that there was a probability of more than 25% that a patient would return to hospital following post-operative discharge. With virtual care, physicians and nurses can identify patients who need medical care and help them avoid a trip back to the hospital. In the PVC-RAM trial, patients were given a tablet and remote monitoring equipment to assess blood pressure, heart rate, respiratory rate, oxygen saturation, temperature and weight. Nurses educated patients how to use the technology prior to discharge. The technology used in the trial was Connected Health by Cloud DX. During the trial, patients kept the equipment for a month, reporting their findings daily. Their outcomes were compared to a group of patients randomized to standard care. Nurses do the bulk of the post-operative virtual monitoring, but if blood sugars are off, or the incision looks infected, the nurse consults the surgeon or perioperative physician. Dr. Michael Jacka, lead investigator for the University of Alberta Hospital site, said this happens a few times a week. Dr. Jacka is an associate professor of anesthesiology at the University of Alberta. Dr. Devereaux said that a third of the urgent surgeries in the trial were related to cancer. While cost-effectiveness has not yet been formally studied, it makes sense to prioritize which patients will benefit most from post-operative virtual care, Dr. Jacka said. Initial results from the University of Alberta Hospital site suggest that those recovering from abdominal surgery, elderly patients and people who have a new ostomy benefit most from the virtual post-operative monitoring, Dr. Jacka said. Dr. Devereaux and Dr. Jacka said medication errors were common post-surgical complications seen in the trial. Patients sent home with changes to their medication may get confused with new doses and new prescriptions. Dr. Jacka noted that confusion was sometimes higher with older patients, who had trouble recalling the postoperative education given in the hospital soon after surgery. You may also like: Montreal hospital experiments with using remote supervisors during surgery While other programs have telephone follow-up with patients, virtual care allows the surgeon to have a visual of the incision, Dr. Jacka noted. Some patients just need reassurance that the incision site looks normal, he said. In other cases, intervention is needed. Dr. Devereaux said one cardiac patient had to be rushed for an emergency pacemaker implant after the nurse monitoring his heart rate virtually noticed it had dropped to 35 beats per minute. As well as saving lives, the virtual monitoring improves the patients’ quality of life, Dr. Devereaux said. He cited the story of a patient who was recovering from bladder cancer surgery at home in Niagara Falls, close to a one-hour drive away from Hamilton where he had his surgery. The patient was experiencing pain and contacted the nurse. Dr. Devereaux was able to connect virtually with the patient, diagnose a urinary tract infection, and send a prescription to the patient’s pharmacy. It all happened on a Saturday night, and the virtual care meant the patient avoided a trip to the emergency room where wait times would have been long and, as Ontario doesn’t have a province-wide EHR, the healthcare staff wouldn’t have known the details of the patient’s surgery. The post-surgical virtual monitoring program, now called surgical transitions, is ongoing at Hamilton Health Sciences Centre thanks to funding from the Ontario government. Nurses provide virtual care 14 hours a day, seven days a week. Six other hospitals are continuing the program, according to Cloud DX. There’s also a plan to study the intervention further in a new trial, called PVC-RAM 2. It will examine how to make the program more efficient and effective, Dr. Devereaux said. You may also like: Ontario earmarks $324M for surgical recovery, ramp up of hospital capacity The program will continue to be essential as surgeons and their colleagues work to clear surgical backlogs. If patients can be safely sent home earlier with monitoring to reduce the risk of readmission, more beds may be available for post-surgical care. In Hamilton alone, Hamilton Health Sciences postponed more than 5,600 non-urgent procedures since April 12, 2021 and St. Joseph’s Healthcare postponed more than 5,700 non-urgent procedures. The study was run by McMaster University’s Population Health Research Institute. PVC-RAM is short for “Post-discharge after surgery using virtual care with remote automated monitoring.” Cloud DX confirmed on June 1 that it had extended its contract with an unnamed provincial health authority to provide remote patient monitoring to patients until March 31, 2022. Cloud DX is paid for each kit and then it charges a monthly connectivity, software and service fee for each patient. The full PVC-RAM study protocol was published in CMAJ in March 2021.

Select hospitals in Ontario, Alberta adopt post-operative virtual monitoring

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