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Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM): protocol for a

Michael H McGillion1, Joel Parlow1, Flavia K Borges1

  • 1School of Nursing (McGillion, Levesque, Lounsbury, Bird, Ouellette), McMaster University, Hamilton, Ont.; Population Health Research Institute (McGillion, Whitlock, Devereaux, Belley-Cote, Borges, Vincent, Lamy, Bangdiwala, Le Manach, Harvey, Conen), Hamilton, Ont.; Department of Anesthesiology and Perioperative Medicine (Parlow, Arellano), Queen's University, Kingston, Ont.; Department of Anesthesiology and Perioperative Medicine (Parlow, Shelley, DuMerton, Arellano), Kingston Health Sciences Centre, Kingston, Ont.; Department of Medicine (Belley-Cote, Yousef, Borges, Marcucci, Chaudhry, Haider, Guyatt, Patel, Conen, Tandon), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (Whitlock, Devereaux, Marcucci, Bangdiwala, Guyatt), McMaster University, Hamilton, Ont.; Departments of Critical Care and Anesthesiology (Jacka), University of Alberta, Edmonton, Alta.; Department of Surgery (Adili, Harlock, Simunovic, Nenshi), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare Hamilton (Adili, LeBlanc, Nenshi, Tandon), Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (Lalu, McCartney, Hamilton), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; Ottawa Hospital Research Institute (Moloo, Lalu, Halman, Forster, Hamilton), Ottawa, Ont.; Department of Anesthesia and Perioperative Medicine (Sehmbi, Nagappa, Yang), Schulich School of Medicine, University of Western Ontario, London, Ont.; Department of Anesthesia and Perioperative Medicine (Sehmbi, Nagappa, Yang), London Health Sciences Centre, London, Ont.; Hamilton Health Sciences (Meyer, Paulin, Pettit, Lamy, Lounsbury, Scott, Patel, Ouellette, O'Leary), Hamilton, Ont.; Department of Anesthesia (Shanthanna, Paul, Le Manach, O'Leary), McMaster University, Hamilton, Ont.; Department of Medicine (Roshanov, Mrkobrada), Schulich School of Medicine, University of Western Ontario, London, Ont.; Department of Internal Medicine (Ofori), University of Port Harcourt, Port Harcourt, Nigeria, West Africa; Department of Medicine (Graham, Taylor), University of Alberta, Edmonton, Alta.; Department of Medicine (Halman, Forster), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Peter), University of Toronto, Toronto, Ont.; Department of Medicine (Marosi), Queen's University, Kingston, Ont.; Alberta Health Services (Deuchar), Alberta, Canada; Department of Surgery (Parry, Schlachta, Schemitsch), University of Western Ontario and London Health Sciences Centre, London, Ont.; Department of Surgery (Williams), University of Alberta, Edmonton, Alta.; Department of Oncology (Meyer), McMaster University, Hamilton, Ont.; Department of Surgery (Pichora), Queen's University and Kingston Health Sciences Centre, Kingston, Ont.; Department of Surgery (Moloo), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital (Waggott), Ottawa, Ont.

CMAJ Open
|March 3, 2021
PubMed
Summary
This summary is machine-generated.

Virtual care with remote automated monitoring (RAM) helps patients discharged after surgery stay alive at home longer. This technology-assisted approach improves post-operative recovery and reduces hospital readmissions.

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Area of Science:

  • Surgical outcomes and patient recovery
  • Digital health technologies in healthcare
  • Postoperative care management

Background:

  • Patients undergoing nonelective surgery face risks of readmission, emergency department visits, or death post-discharge.
  • The COVID-19 pandemic highlighted the need for innovative remote patient monitoring solutions.
  • The Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM) trial was initiated to address these challenges.

Purpose of the Study:

  • To evaluate the effectiveness of virtual care combined with remote automated monitoring (RAM) compared to standard care.
  • To determine if this intervention increases the number of days adult patients remain alive at home after discharge following nonelective surgery.
  • To provide insights into managing post-surgical patients during and after the COVID-19 pandemic.

Main Methods:

  • A randomized controlled trial involving 900 adult patients from 8 Canadian hospitals undergoing nonelective surgery.
  • Patients were randomly assigned to either virtual care with RAM or standard care.
  • The experimental group used a tablet for daily biophysical measurements and recovery surveys, with remote monitoring and nurse-led care escalation.

Main Results:

  • The primary outcome measured was the number of days alive at home within 30 days post-randomization.
  • Outcome adjudicators were masked to group allocations to ensure unbiased assessment.
  • Data collection involved daily patient-reported outcomes and automated vital sign monitoring.

Conclusions:

  • The PVC-RAM trial findings will inform the management of post-discharge surgical patients, particularly during public health crises.
  • The study offers valuable insights for optimizing nonelective surgical patient care in both pandemic and non-pandemic settings.
  • Dissemination strategies include a multimedia resource center, policy briefs, publications, and media engagement.