Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial

Abstract

BackgroundInadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting.ObjectiveThe objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC).MethodsA multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group.ResultsThe technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019.ConclusionsProgress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients’ preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability a...

Mobile Applications in Clinical and Perioperative Care for Anesthesia: Narrative Review

“…The Listeo+ app provides personalized information to patients, reminders for preoperative recommendations, and a channel for various provider communications. Listeo+ is currently being tested in a multicenter RCT to evaluate the percentage of compliance to preoperative recommendations, thereby decreasing the rate of surgery cancellations [ 35 ].…”

Evaluating and Enhancing the Preparation of Patients and Families before Pediatric Surgery

“…Since our thematic analysis identified a major theme of being able to visually see where to go on the day of surgery, we felt it was appropriate to focus on an ACH-specific resource. We found that a variety of generic (non-site specific) applications or online videos are available for surgical preparation [ 12 , 13 , 14 ] and we are continuing to explore options for further development of a site-specific app. A strength of our study was the ability to directly compare a family’s sense of preparedness for surgery with and without accessing the in-person Surgery 101 program.…”

<p>What Kind Of A Mobile Health App Do Patients Truly Want? A Pilot Study Among Ambulatory Surgery Patients</p>

“…This finding indicates that there may be a convenient approach to communication between ambulatory surgery patients and HCPs. Because an increasing number of surgeries are being performed as ambulatory surgeries, the HCPs in ambulatory surgery center have gradually become overworked17 even though we established a special ambulatory surgery follow-up center in our hospital to address patients’ needs after surgery (two nurses are in charge of follow-up-related affairs), which could still not meet all demands. In this case, communication with HCPs through m-health apps may be a compromise to solve this problem to some extent, as this function can fulfill patients’ requirements of communicating with HCPs anytime and anywhere.…”

“…The three major ambulatory surgery types performed in the center are laparoscopic cholecystectomy (LC), mammotome minimally invasive (MMT) biopsy and resection of intestinal polyps (RIP). Since an increasing number of surgeries have been performed as ambulatory surgeries, the HCPs in our ambulatory surgery center have gradually become overworked17 Due to this situation, we would like to design an m-health app for ambulatory surgery centers to provide patients with more convenient health-care services and improve the working efficiency of HCPs. Before the m-health app can be systematically implemented, a comprehensive understanding of potential users and user habits is necessary18 M-health apps based on user-centered design have already been proven to be more practical and fully utilized than other m-health apps not designed with a user-centered approach;19,20 thus, surveys of patients’ preferences regarding m-health apps can help effectively design m-health apps and enhance patients’ engagement in m-health app interventions.…”