An observational study to assess the feasibility of remote monitoring of patients in the early postoperative period after elective surgery

Abstract

Background and Objectives: The utility of postdischarge remote monitoring with patient self-measurement of physiological parameters has not been utilized in the elective colorectal surgical setting till date. Before full application of this utility, patient-acquired measurements’ accuracy, and ability to detect deviation from normal physiological must be assessed. This study aims to ascertain the congruency of patient-measured and nurse-measured readings in the postoperative in-hospital setting, before future application in the home setting. Methods: This is a prospective single-institution study comparing patient and nurse measured readings of blood pressure, heart rate, oxygen saturation, and temperature, in ambulatory patients in the postoperative setting. Patients were provided with and trained on the usage of a handheld computing device with bluetooth-enabled measuring adjuncts preoperatively. Patients were instructed to acquire two sets of readings per day for 2 days. These were compared with nurse-acquired measurements and extrapolated to the modified “National Early Warning Score” system. Inter-rater concordance was analyzed using the Bland-Altman method for raw physiological measurements and for modified-National Early Warning Score (NEWS) risk and response categories. Results: A total of 40 elective colorectal patients were prospectively approached. Twenty-seven completed the study with 25 patients (15 males, age range 18-79, undergoing a variety of colorectal procedures) accruing a total of 98 datasets of physiological parameter readings. There were no significant differences/bias between blood pressure (P = 0.572), heart rate (0.122), and oxygen saturation (P = 0.308) readings. Patient and linked nurse measurements for all patients elicited the same modified NEWS clinical risk and required response in all instances. Conclusion: Patient self-measurement of physiological parameters and subsequent derived modified NEWS categories using a remote monitoring system are comparable to nurse-acquired measurements. Remote monitoring is technically feasible, and the next steps would be to trial this technology in the home setting.