An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures: The ACTFAST-3 Randomized Clinical...

Area of Science:

• Anesthesiology
• Health Services Research
• Medical Informatics

Background:

• Telemedicine for clinical decision support is increasingly adopted in healthcare.
• Its effectiveness in improving intraoperative care remains largely unassessed.
• This study addresses the gap by evaluating a novel telemedicine intervention during surgery.

Purpose of the Study:

• To pilot and evaluate a real-time intraoperative telemedicine decision support program.
• To determine if the intervention reduces postoperative hypothermia and hyperglycemia.
• To assess other quality of care measures during surgery.

Main Methods:

• A single-center pilot randomized clinical trial (ACTFAST-3) involving 26,254 adult surgical patients.
• Patients were randomized to either usual care or telemedicine-augmented care (Anesthesiology Control Tower).
• The intervention involved remote monitoring and decision support from a team of anesthesia clinicians.

Main Results:

• No significant difference in the avoidance of postoperative hyperglycemia or hypothermia between the intervention and control groups.
• Intraoperative glucose measurement increased in patients with diabetes in the intervention group.
• Secondary outcomes, including hypotension and anesthetic overuse, showed no significant differences.

Conclusions:

• Anesthesia care quality measures did not significantly differ between telemedicine-augmented care and usual care.
• The current telemedicine intervention did not demonstrably affect targeted intraoperative care practices.
• Streamlining clinical decision support and workflows is recommended for future telemedicine programs to achieve measurable improvements.