Assessment of Ileostomy Output Using Telemedicine: A Feasibility Trial
Brian K Bednarski1, Rebecca S Slack2, Matthew Katz1
1Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Background:
Ileostomies are a routine part of the care of patients with rectal cancer, but are associated with significant risk for dehydration, readmission, and acute kidney injury. Telemedicine has proven beneficial in decreasing readmission in chronic medical illnesses, but its utility in patients with an ileostomy is not well studied.
Objective:
The purpose of this study was to evaluate the feasibility of televideoconferencing in the assessment of ileostomy output.
Design:
An institutional review board-approved, prospective clinical trial was conducted at a single institution from November 2014 through December 2015.
Settings:
The study was conducted in a single, large academic medical center.
Patients:
Patients >18 years of age undergoing surgery with plans for ileostomy were eligible.
Interventions:
Televideoconference assessments of ileostomy output and the need for medical intervention were conducted during the postoperative stay and compared with in-person assessment.
Main Outcome Measures:
The primary end point of the trial was the feasibility of using teleconferencing to assess the need for medical intervention, defined as 90% agreement between telemedicine and in-person assessments. Secondary end points included patient/provider satisfaction, and correlative studies examined dehydration events and readmission.
Results:
Twenty-seven patients underwent 44 teleconferencing assessments of ileostomy output. Compared with in-person treatment decisions, there was a 95% match (95% CI, 85%-99%). The readmission rate for the study participants was 31%, and 18% experienced dehydration events. Both patients and faculty responded favorably to surveys regarding the use of telemedicine in the perioperative period.
Limitations:
The study is limited by its in-hospital use of technology and small sample size.
Conclusions:
Televideoconference evaluation is a feasible, reliable means of assessing ileostomy output with high patient and physician acceptance. Our pilot study provides rationale for further study in the postdischarge setting for patients with ileostomies. The incorporation of televideoconference assessment within a teledischarge program may enable early intervention to improve patient outcomes. See Video Abstract at http://links.lww.com/DCR/A455.
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