Postoperative Home Monitoring After Joint Replacement: Feasibility Study

Abstract

Background We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. Objective The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%. Methods Patients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. Results We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to “I would recommend the Remote Monitoring System program to future patients” was 4.5 (interquartile range 4-5), with 1 being “strongly disagree” and 5 “strongly agree.” At 30 days postop, there was no mortality or readmission. Conclusions This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals. Trial Registration ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk)

Management of patients undergoing same-day discharge primary total hip and knee arthroplasty

“…6,28,55 Lastly, postdischarge supports and surveillance vary greatly, ranging from merely the ability to call the clinic or surgeon's administrative assistant if there are issues, to remote postoperative home monitoring systems that wirelessly transmit vital signs and pain scores in real time. 56,57 Usual postoperative wound checks are appropriate. Studies that have compared patients treated using standard inpatient protocols with those treated under an outpatient protocol have shown no difference in the rate of superficial or deep surgical infections.…”

Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case

“…Over the last decade, implementation science [1,2] has experienced significant progresses resulting in well-accepted conceptual frameworks for assessment of healthcare services [3][4][5][6]; that should cover the following three areas: i) deployment strategies aiming at identifying barriers/facilitators for service adoption; ii) comprehensive approaches to assess outcomes; and iii) identification of key performance indicators (KPI) feeding customized dashboards for continuous long-term quality monitoring of complex interventions [7][8][9][10]. Applicability of such recommendations for evaluation of integrated care services (ICS) [3,[11][12][13] in real-world settings is still an issue limiting service adoption, as well as comparability and transferability across sites [14,15].…”

Health Outcomes from Home Hospitalization: Multisource Predictive Modeling

“…This study relies on the assumption that multisource predictive modeling facilitating clinical decision support at 2 key time points—(1) at entry, and (2) at HH/ED discharge—could be useful to enhance service outcomes. Risk assessment at entry may contribute to reducing undesirable events during the episode of HH/ED, whereas the assessment of unexpected events after discharge will likely contribute to improving transitional care [ 12 , 13 ] and better definition of personalized care pathways within a care continuum scenario [ 14 ].…”