Post Discharge after surgery virtual care with remote automated monitoring technology trial
New Technology, Therapies, eHealth & mHealth
Potential for spread: Given the high-rate of stakeholder buy-in (e.g. surgeons, patients, hospital executive) this technology can be readily transferred to other institutions. Other regional centres have already consulted our group to better understand how to implement a successful program (e.g. Hawkesbury General Hospital). As mentioned above, multiple sites across the country have continued their post-surgical virtual care programs. Several knowledge translation strategies are being employed: 1) Publication – trial results were published in the BMJ (https://doi.org/10.1136/bmj.n2209); 2) Multiple invited presentations 2021-2022(e.g. Ontario Health). Meetings were attended by ministry leadership and by other centres interested in remote monitoring for surgical transitions in care; 3) Invited presentations in sessions for Innovations in Perioperative Care by the Canadian Anesthesiologists’ Society (national meeting 2022); 3)Continued stakeholder engagement and program improvement through Plan-Do-Study-Act cycles (funded by a TOHAMO Quality Improvement Grant 2022).
Beyond the Innovation Fund: Based on the promising results of the trial, we successfully received program funding from the Ontario Health Remote Care Management/Surgical Transitions Remote Care Monitoring for two cycles (2021-2022, 2022-2023). This funding has paid for nursing staff as well as a project manager
Emergency department visits and readmissions post-surgical discharge are high (10-20%). This may reflect the fact that, when discharged home, patients are no longer monitored, care largely relies on family members, and access to health care is limited. In order to address this issue we created the Virtual Recovery After Surgery program at The Ottawa Hospital.
Patient in the program are taught how to use innovative virtual care technology to use take daily surgical recovery monitoring surveys and transmit vitals to a virtual nurse (up to one month following surgery). Nurses regularly meet with patients to review their health, reinforce best practices for recovery, and undertake medication reviews. Any issues are escalated to a physician on call for the service. IFPOC funding allowed us to measure the impact of this service in a randomized control trial. We found that services led to high patient satisfaction and improved pain control ( a frequent cause of readmissions). Moreover, our high intensity service (i.e. checking in on patients and escalating care) was associated with decreased acute care visits.
Innovation: Few programs exist worldwide for virtual recovery after surgery. The trial conducted was the largest one to date and multiple programs were established at participating sites across Canada. IFPOC funding has allowed us to build a virtual recovery program that is being recognized provincially and nationally
McGillion MH, Parlow J, Borges FK, Marcucci M, Jacka M, Adili A, Lalu MM, et al.PVC-RAM-1 Investigators. Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial. BMJ. 2021 Sep 30;374:n2209. doi: 10.1136/bmj.n2209