Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial

• Published in: BMJ (Online) Vol. 374; p. n2209
• Main Authors: McGillion, Michael H, Borges, Flavia K, Jacka, Michael, Adili, Anthony, Lalu, Manoj M, Ouellette, Carley, Bird, Marissa, Yang, Homer, Tandon, Vikas, Hamilton, Gavin M, Conen, David, Harvey, Valerie, Mian, Rajibul, Bangdiwala, Shrikant I, Gao, Peggy, Graham, Michelle, Marosi, Kristen, Haider, Shariq, Deuchar, Lesly, LeBlanc, Brandi, McCartney, Colin J L, Schemitsch, Emil H, Vincent, Jessica, DuMerton, Deborah, Paulin, Angela Djuric, Simunovic, Marko, Williams, David C, Halman, Samantha, Harlock, John, Schlachta, Christopher M, Yousuf, Haroon, Petch, Jeremy, Moloo, Husein, Sehmbi, Herman, Waggott, Melissa, Belley-Cote, Emilie P, Devereaux, P J, Payne, Darrin, Srivastava, Siddhartha, Nguyen, Lisa, Vowotor, Elorm, Peponoulas, Emile, Webster, Angela, Doyle, Tammy, Srivaratharajah, Kajenny, Bedini, Deborah, Chu, Victor, Busse, Jason, Bender, Duane, Brooks, Dina, Power, Patricia, Chakroborty, Amitabha, Raza, Samir, Lawrence, Kelly, Cowan, David, Kelly, Stephen, Reid, Susan, Greene, James, Buchanan, Brian, Rewa, Oleksa, Jomha, Nadr, Ritchie, Bruce, Fairey, Adrian, Choi, David, Stewart, Tom, Farrell, Melissa, Tierney, Sarah, Hicks, Shawn, Krolczyk, Greg, Rao, Purnima, Moffett, Stephane, Code, Catherine, Rousseau, Melissa, Gray, Catherine, Tawil, Youssef, Beckerleg, Weiwei, Seely, Andrew, Bearnes, Reece, Fergusson, Dean, Abou Khalil, Jad, Momtazi, Moein, Breau, Rodney, Vigil, Humberto, Chan, James, Ngyuen, Freddy, Nicolaou, George, Fayad, Ashraf, Garg, Amit, Vandersluis, Cathy, Churcher, Cheryl, Maxwell, Brenda, Boulton, Melfort, Wang, Michael, Khan, James, Blake, Lori, Dyal, Leanne, Fernandez, Arielle, Koh, Peter, Liu, Yan Yun, Tong, Wesley
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 30.09.2021; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: Aftercare - methods; Aged; Automation; Blood pressure; Body temperature; Body weight; Canada - epidemiology; Coronaviruses; COVID-19; COVID-19 - epidemiology; Delirium; Elective surgery; Female; Health care; Heart failure; Heart rate; Hospitalization; Hospitals; Humans; Infections; Male; Medication Errors - statistics & numerical data; Middle Aged; Monitoring, Ambulatory - methods; Nurses; Pain; Pain, Postoperative - epidemiology; Pandemics; Patient Discharge; Patients; Physicians; Postoperative Period; Respiration; Sepsis; Surgeons; Surgery; Surgical Procedures, Operative - mortality; Surgical Procedures, Operative - nursing; Telemedicine - methods; Canada
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj.n2209

AbstractObjectiveTo determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic.DesignMulticentre randomised controlled trial.Setting8 acute care hospitals in Canada.Participants905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up.InterventionParticipants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre’s usual care. Patients, healthcare providers, and data collectors were aware of patients’ group allocations. Outcome adjudicators were blinded to group allocation.Main outcome measuresThe primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation.ResultsAll 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval −0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (−0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation.ConclusionVirtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function.Trial registrationClinicalTrials.gov NCT04344665.