JMIR Publications

ABSTRACT

Background:

Hospital stay after major surgery is shorter than ever before. Although enhanced recovery and early discharge have many benefits, some complications will now first manifest themselves in the home setting. Remote patient monitoring in the first days after hospital discharge with wearable sensors may capture clinical deterioration earlier, but is largely uncharted territory.

Objective:

this study aimed to assess the technical feasibility and experiences of patients discharged home after esophagectomy while being remotely monitored with a wireless patch sensor. In addition, we determined whether observing vital signs with a wireless patch sensor in these patients influences clinical decision making.

Methods:

In an observational feasibility study, vital signs of patients after esophagectomy were monitored with a wearable patch sensor (VitalPatch, VitalConnect Inc., San Jose, CA) during the first seven days at home after hospital discharge. Vital signs trends were shared with the surgical team once a day and they were asked to check the patient’s condition by phone each morning. Patient experiences were evaluated with a questionnaire and technical feasibility was analyzed on a daily basis as the percentage of data loss and gap durations. In addition, the number of patients in which a change in clinical decision was made based on the results of remote vital signs monitoring at home was assessed.

Results:

20 patients completed 140 days (7 days each) of home monitoring with the wearable patch sensor. Each of the patients had good recovery at home, and remotely observed vital signs trends did not alter clinical decision making. Patients appreciated that surgeons checked their vital signs daily (mean 4.4 / 5) and were happy to be called by the surgical team each day (mean 4.5 / 5). Wearability of the patch was high (mean 4.4 / 5) and no reports of skin irritation were mentioned. Overal data loss of vital signs measurements at home was 25%; both data loss and gap duration varied considerably among patients.

Conclusions:

Remote monitoring of vital signs combined with telephone support from the surgical team was feasible and well perceived by all patients. Future studies need to evaluate the impact of home monitoring on patient outcome as well as cost-effectiveness of this new approach.