JMIR Publications

ABSTRACT

Background:

Hospital stay after colorectal surgery is increasingly reduced by enhanced recovery and early discharge protocols. As a result, postoperative complications may frequently manifest in the home setting potentially leading to Emergency Room presentations and readmissions. Virtual care interventions after hospital discharge may capture clinical deterioration at an early stage and hold promise for the prevention of readmissions and overall better outcomes. Recent technological advances have enabled continuous vital signs monitoring by wearable wireless sensor devices. However, their potential for virtual care interventions after discharge in this patient category is currently unknown.

Objective:

To determine the feasibility of a virtual care intervention consisting of continuous vital signs monitoring with wearable wireless sensors as well as teleconsultations for patients discharged after colorectal surgery.

Methods:

In a single-center observational cohort study, patients were monitored at home for five consecutive days after discharge. Daily vital signs trend assessments and telephone consults were performed by a remote patient monitoring department. Intervention performance was evaluated by analyzing vital sign trend assessments and telephone consult reports. Outcomes were categorized in no concern, slight concern or serious concern. Serious concern would prompt contact with the surgeon on call. In addition, the quality of the vital signs data was determined and the patient experience was evaluated.

Results:

Twenty-one patients participated in the study. Of the 104 (99%) successfully performed vital signs trend, 68% did not raise any concern, 16% were unable to assess because of data loss, and none led to consultation of the surgeon. Of the 60 (98%) successfully performed telephone consults, 85% did not raise any concern and only one resulted in consulting the surgeon. An 67% agreement was found between vital signs trends assessments and telephone consults. There were three readmissions (14%), but the monitoring intervention did not influence clinical course in any of these cases. Overall completeness of the 2,347 hours vital signs trends data was 46.3% (range 5-100%). Patient satisfaction score was 8 out of 10 (IQR7-9).

Conclusions:

A home monitoring intervention of patients discharged after colorectal surgery was found to be feasible given its high performance and high patient acceptability. However, the intervention design needs further optimization before the true value of remote monitoring for early discharge protocols, prevention of readmissions and overall patient outcomes can be adequately determined.