Post-surgical support with hospital and home monitoring

Objectives

• Improve recovery outcomes and the experience of seniors undergoing cardiac or vascular surgeries
• Reduce hospital and ED readmissions
• Reduce unrelieved acute post-surgical pain
• Reduce infection/sepsis and other adverse events
• Increase patient and clinician satisfaction

Patient Eligibility Criteria

Seniors aged 60 or older who have undergone major cardiac or vascular surgery

Model

The SMArTVIEW trial involves two components related to a patient’s journey: in-hospital monitoring and hospital-to-home monitoring with self-management support.

In-Hospital Monitoring

• Patients in the hospital are equipped with wireless devices to continuously monitor respiratory rate, heart rate, blood pressure and oxygen saturation.
• The combined data from these devices generate an early warning score. If this score is above a set threshold, an alert is sent to a ward nurse’s smartphone. If no action is taken within a defined time period, another alert is sent to the charge nurse for immediate follow-up with the patient.

Hospital-To-Home Monitoring (30 days post discharge)

• Patients are provided a home monitoring kit prior to hospital discharge containing a tablet and Bluetooth-enabled vital sign trackers: blood pressure monitor, weight scale and oxygen saturation probe.
• Vital signs are recorded a minimum of three times per day and are remotely monitored by a team of SMArTVIEW nurses, who conduct remote video assessments daily during which they visually inspect the surgical wounds and perform a comprehensive assessment, including pain assessment. Recovery issues are managed remotely in collaboration with the surgical team.
• Patients work with their SMArTVIEW nurse to set achievable goals to improve their self-management skills in relation to their sleep, nutrition, pain management, physical activity, and overall well-being.
• Patients can also communicate with other patients assigned to the same cohort to share success stories and challenges, and to problem solve.

Technology Type:
The SMArTVIEW study utilizes Philips’ technologies with the functionality to enable the remote monitoring of biometric and patient response data, video visits, and messaging.

Outcomes

As the SMArTVIEW trial is in progress, results are pending, however initial patient testimonials attest to the knowledge, care and sympathy of the SMArTVIEW nurses and highlight:

• The benefit of having access to a hospital care team while recovering at home
• Feeling empowered to take care of themselves
• Several corrective actions undertaken by SMArTVIEW nurses from the data received via remote monitoring

Change Required to Support the Model

For the in-hospital monitoring, nurses on the ward required training on the monitoring device and how to respond. It was important to ensure that this new level of monitoring was not replacing usual care but adding to it.

A SMArTVIEW nursing role was created to support this model and nurses were trained to use the daily monitoring data and trending reports to identify new and emerging issues. SMArTVIEW nurses also had to acquire new skills to virtually assess the patient’s health and well-being and act as a coach, setting wellness goals with the patients. The SMArTVIEW trial currently operates with a team of six registered nurses.

Adoption Rate

• 412 patients have been randomized for the In-hospital monitoring study component
• The SMArTVIEW trial intends to enrol 800 participants by April/May 2020

Disclaimer

OTN is an independent, not-for-profit organization funded by the Government of Ontario. The views expressed here are the views of OTN, or the respective authors if a third-party, and do not necessarily reflect those of the Province. For further information, please note the Proprietary Rights detailed within the OTN Terms of Service available at https://otn.stagingotn.ca/terms-conditions/