Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial

Abstract

Objective To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. Design Multicentre randomised controlled trial. Setting 8 acute care hospitals in Canada. Participants 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. Intervention Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre’s usual care. Patients, healthcare providers, and data collectors were aware of patients’ group allocations. Outcome adjudicators were blinded to group allocation. Main outcome measures The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. Results All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval −0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (−0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. Conclusion Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. Trial registration ClinicalTrials.gov NCT04344665 .

Best practices for the use of telemedicine

“…“If it is well‐designed and well‐executed, telemedicine visits can be just as good as in‐person visits,” he said. Evidence confirms the effectiveness of telemedicine in the perioperative setting 9,10 . One study found that telemedicine for preoperative consults (e.g., sharing photographs of biopsied skin cancer) in patients undergoing Mohs micrographic surgery decreased time to treatment by two weeks; increased the percentage of lesions treated within 60 days; and saved patients an average of 162.7 minutes, 144.5 miles, and $60 for travel compared with standard in‐person visits 9 .…”

“…One study found that telemedicine for preoperative consults (e.g., sharing photographs of biopsied skin cancer) in patients undergoing Mohs micrographic surgery decreased time to treatment by two weeks; increased the percentage of lesions treated within 60 days; and saved patients an average of 162.7 minutes, 144.5 miles, and $60 for travel compared with standard in‐person visits 9 . Another study found that virtual postoperative consultations (e.g., wound evaluation, medication review) and monitoring (e.g., blood pressure) via a tablet in patients who underwent nonelective surgery resulted in greater detection and correction of medication errors and less pain compared with standard in‐person care 10 …”

“…9 Another study found that virtual postoperative consultations (e.g., wound evaluation, medication review) and monitoring (e.g., blood pressure) via a tablet in patients who underwent nonelective surgery resulted in greater detection and correction of medication errors and less pain compared with standard in-person care. 10…”

Quality and Safety in the Literature: May 2022

“…In this context, McGillion and colleagues performed a multicentre randomised controlled trial comparing the impact of a remote automated monitoring (RAM) programme to usual care after hospital discharge for patients undergoing non-elective surgery 46. The trial was conducted in eight acute care hospitals in Canada, with patient recruitment between 23 April 2020 and 25 July 2020.…”

The Utility of Telemedicine to Manage Post-Operative Pain

“…In an RCT that studied 903 patients over the age of 40, the benefits of telemedicine in post-operative pain for non-elective surgeries were also demonstrated [23]. Researchers found that through a telemedicine intervention that utilized a program that measured vital signs in patients daily, had patients complete a daily recovery survey, and enabled patients to send daily pictures of any wounds to nurses and chat with them virtually, patients had decreased pain compared to control group patients [23].…”