Post Op Home Monitoring after Joint Replacement (POHM)
Chronic Care and Patient-Centred Care
Post-op 30-day readmissions, re-operations, and Emergency Department (ED) visits currently are 5 – 13%. With early discharge, patients are often unsure of signs or symptoms (S+S), resulting in extra ED visits for minor S+S or delayed repatriation in major complications. POHM monitors vital signs (VS) and pain scores via remote wireless connectivity and a smartphone. Results show a continuity of care; excellent patient satisfaction with early or same day discharge; reduced ED visits for minor S+S; and could expedite repatriation in serious complications. Preliminary cost analysis showed savings and patients felt secure after early discharge. The technology and care paths are validated as a reliable acute care tool. Negotiations with OTN for partnership and scalable implemention are on-going.
Early discharge (EDc) after hip or knee replacement (HA or KA) is now possible. However, after HA or KA, 3.1% experience DVT, or other complications. Postop myocardial infarctions (45.8%) occur after post-operative day (POD) 2. With EDc, therefore, complications may occur as out-patients. Also, more medication errors occur at transition points; i.e. hospital discharge. We hypothesize that home monitoring allows better transition of care and earlier intervention of post-operative complications at home. This is a preliminary report on home monitoring with wireless connectivity on pain scores and VS (non-invasive blood pressure, heart rate, and pulse oximetry) with alerts sent to the iPhone of a healthcare team member.
After REB approval, 54 patients were enrolled: 21 males, 33 females; 9 total hips; 4 unipolar hips; 26 total knees; 15 hemi-knees; 43 under spinal anesthesia and 4 under GA. The median wireless transmission rates were 99.5%, 98.3%, 97.9%, 97.8%, 90.9% on DOSx, POD1, 2, 3, 4 respectively. Overall, 3540 out of 3672 transmissions were successfully received, and the median transmission completion rate was 97.9% (IQR 97.8 – 98.8%). The average phone call per patient was 1.06 ± 1.02 with a median of 1 (IQR 1-2) over the 4 days. The median response to “I would recommend the Remote Monitoring System program to future patients” was 4.5 (IQR 4-5), 5 being “strongly agree”. At 30-day follow-up, all were at home; no mortality; 2 visited the ED on POD 15 and POD 12 for pain and no re-admissions. Preliminary results show the POHM patient costs were mean $5377.18 ± $1530.99, median $5111.29 (IQR $4548.12 – $5608.18) while the average control costs were mean $8049.78 ± $1811.43, median $7861.46 (IQR $6886.81 – $9065.13).
Data interaction with all patients every day supports the feasibility of postop home monitoring.