Evaluating Safety and Efficacy of Follow-up for Patients With Abdominal Pain Using Video Consultation (SAVED Study): Randomized Controlled Trial

Abstract

Background The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. Objective The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. Methods The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). Results A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups. Conclusions The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. Trial Registration ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.

Digital Health Solutions for Mental Health Disorders During COVID-19

“…This was illustrated in the SAVED study operationalizing telehealth for complexed emergency services ( 51 ). Digital operationalization of mental health services can be similarly achieved using combinations of digital tools in comprehensive services such as Illness Management and Recovery (IMR) Programs ( 52 ).…”

“…Participatory approaches like these with design-thinking have been used to operationalize tele-health in complexed emergency services ( 51 ), as well as develop solutions with targeted applications such as AI chatbots for automated adolescent mental health coaching ( 54 ). In tandem, it is important to address the needs of vulnerable populations that may fail to seek care, such as potential domestic violence or child abuse victims ( 9 ).…”

Digital health during COVID-19: lessons from operationalising new models of care in ophthalmology

“…13,55 Technology combinations that have been similarly applied outside ophthalmology include the Babylon conversational AI-chat bots that triage patients and refer those requiring further assessment onwards for a video consultation. 56 Hybrid telehealth (the stacked combination of digital and physical clinical services) has also been illustrated in the SAVED trial of text-based asynchronous reviews with synchronous video consultations at emergency services in Singapore, 57 highlighting its potential to facilitate early discharge and reduce time in hospitals.…”

Digital health for patients with chronic pain during the COVID-19 pandemic

“… 14 These considerations can be incorporated together in a well-planned study using approaches such as design thinking, 15 as illustrated in the SAVED trial of hybrid synchronous-asynchronous digital telereview of patients with acute undifferentiated abdominal pain. 16 The SAVED trial demonstrated effective operationalisation of a digital telehealth intervention along with potential manpower and time savings that are much needed to expand service capacity in the context of the ongoing pandemic.…”

“…This ‘sorting conveyor’ model is beneficial to leverage digital solutions to address the needs of patients and reduce unnecessary healthcare presentations, thereby helping to reduce risks of healthcare associated transmission of COVID-19. 16 That said, a recent review reported that most healthcare applications of chat bots lack sufficient validation of clinical outcomes. 25 This is a crucial step that is needed for these solutions to be safely deployed.…”