In an effort to prepare for surges in demand during the COVID-19 pandemic, hospitals everywhere are looking for strategies to manage their patient capacity. Now, Kingston Health Sciences Centre (KHSC) is one of six hospital organizations taking part in a national study on remote patient care following surgery.
“There may be some positive spin-offs of this unfortunate pandemic,” says Dr. Joel Parlow, one of KHSC’s principal investigators for the study. “There is no doubt that the future of medicine will involve much more care provided remotely, and this project will place KHSC at the forefront of new ways to care for surgical patients.”
The study will test the effectiveness of virtual care and remote monitoring technology on unplanned hospitalizations and emergency visits. Patients are setup with an at-home technology called Connected Health by Cloud DX, which includes a tablet and remote monitoring equipment that assess six biophysical parameters: blood pressure, heart rate, respiratory rate, oxygen saturation, temperature and weight.
Nurses assist patients with setup over the phone once they’ve been discharged from hospital. In addition to recording their vital signs, patients complete daily surveys that assess their recovery. KHSC said all data is relayed wirelessly to the nurses, who review it to ensure patients are receiving appropriate care.
Kingston resident Herbert Rae became the first of 200 KHSC patients enrolled in the program following an emergency gallbladder surgery in late May. He said he’s had a positive experience.
“If it weren’t for the need to keep emergency department visits for emergencies during the COVID pandemic, I don’t think I would have experienced the excellent virtual care I received in the comfort of my home after my hospital stay,” Rae said.
“My 87-year-old mom was really happy that I was receiving this level and quality of care after my operation, as the pandemic meant that she wasn’t able to visit me in person and make sure I was doing okay,” he added.
Patients receive daily assessments for the first 16 days at home after surgeries, and every other day for the remainder of the 30-day enrollment.
“Patients are at highest risk for complications in the first 30 days after surgery, with about 20 per cent returning for emergency care or hospitalization,” said Dr. Parlow.
KHSC said eleven nurses run the central command centre 24 hours a day, seven days a week. Anesthesiologists and General Internal Medicine doctors also work on-call, connecting with patients through two-way secure video and texting to address issues that arise.
“By connecting with patients and helping them seek needed medical treatments early, we can potentially reduce the number of hospital re-admissions and increase our capacity to do more surgeries,” Dr. Parlow added.
‘The way of the future’
Approximately half of the KHSC patients recruited to the study will receive the Connected Health setup. The other half will have received the current standard care, which is at the discretion of each surgeon and typically includes an in-person clinic visit in two to eight weeks after discharge from the hospital.
Registered nurse Tammy Doyle said she sees many benefits to the program. “I can really see this being the way of the future, pandemic or not,” she said. “I believe having patients actively involved in their care in this way will ultimately improve their health outcomes and their relationships with health care providers like me.”
Doyle said she and the care team have already helped many patients avoid returns to the emergency department, or calls to their family doctors, by managing their pain remotely. On the flip side, in an emergency, she said the care team has been able to direct patients to the hospital for life-saving treatment when needed.
At the end of the 30 days, a final progress report is sent to participants’ family doctors, noting any issues or concerns during their involvement in the study.
“Regardless of patients’ specific recovery experiences, the patients with whom I’ve worked have expressed to me a sense of comfort knowing I was in contact with them regularly and was following their progress,” said Doyle.
The study, launched by a team of researchers and health care providers at the Population Health Research Institute of McMaster University, is recruiting 900 adults in Canada who have undergone semi-urgent cancer surgeries, urgent surgeries such as hip fractures, or emergency surgeries such as a ruptured abdominal aortic aneurysm.
“I’m very proud of our team’s efforts, which have resulted in KHSC being the number one recruitment site for the project,” says Dr. Parlow. Co-investigators in this multidisciplinary program include three anesthesiologists, three internal medicine specialists, four surgeons and several nurses.
In addition to Kingston Health Sciences Centre, participating hospitals include Hamilton Health Sciences, St. Joseph’s Healthcare Hamilton, London Health Sciences, The Ottawa Hospital, and University of Alberta Hospital.
Queen’s Departments of Anesthesiology and Perioperative Medicine, Surgery, and Medicine donated funding for the project. KHSC supported the project through the monitoring nurses and providing the monitoring equipment. Seed funding for the trial was also received through Roche Canada’s COVID-19 Innovation Challenge.