Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial. (30th September 2021)

• Record Type: Journal Article
• Authors: McGillion, Michael H; Parlow, Joel; Borges, Flavia K; Marcucci, Maura; Jacka, Michael; Adili, Anthony; Lalu, Manoj M; Ouellette, Carley; Bird, Marissa; Ofori, Sandra; Roshanov, Pavel S; Patel, Ameen; Yang, Homer; O'Leary, Susan; Tandon, Vikas; Hamilton, Gavin M; Mrkobrada, Marko; Conen, David; Harvey, Valerie; Lounsbury, Jennifer; Mian, Rajibul; Bangdiwala, Shrikant I; Arellano, Ramiro; Scott, Ted; Guyatt, Gordon H; Gao, Peggy; Graham, Michelle; Nenshi, Rahima; Forster, Alan J; Nagappa, Mahesh; Levesque, Kelsea; Marosi, Kristen; Chaudhry, Sultan; Haider, Shariq; Deuchar, Lesly; LeBlanc, Brandi; McCartney, Colin J L; Schemitsch, Emil H; Vincent, Jessica; Pettit, Shirley M; DuMerton, Deborah; Paulin, Angela Djuric; Simunovic, Marko; Williams, David C; Halman, Samantha; Harlock, John; Meyer, Ralph M; Taylor, Dylan A; Shanthanna, Harsha; Schlachta, Christopher M; Parry, Neil; Pichora, David R; Yousuf, Haroon; Peter, Elizabeth; Lamy, Andre; Petch, Jeremy; Moloo, Husein; Sehmbi, Herman; Waggott, Melissa; Shelley, Jessica; Belley-Cote, Emilie P; Devereaux, P J;
• Other Names: author non-byline.; Payne Darrin author non-byline.; DaCunha Rachael author non-byline.; Patel Sunil author non-byline.; Yacob Michael author non-byline.; Srivastava Siddhartha author non-byline.; Nguyen Lisa author non-byline.; Nickel Curtis author non-byline.; Hands Tyler author non-byline.; Vowotor Elorm author non-byline.; Peponoulas Emile author non-byline.; Webster Angela author non-byline.; Doyle Tammy author non-byline.; Srivaratharajah Kajenny author non-byline.; Szalay David author non-byline.; Bedini Deborah author non-byline.; Chu Victor author non-byline.; Busse Jason author non-byline.; Carroll Sandra author non-byline.; Bender Duane author non-byline.; Brooks Dina author non-byline.; Gregus Krysten author non-byline.; Power Patricia author non-byline.; Williams Dale author non-byline.; Chakroborty Amitabha author non-byline.; Raza Samir author non-byline.; Ahmed Amna author non-byline.; Lawrence Kelly author non-byline.; Hunt Derek author non-byline.; Cowan David author non-byline.; Pinthus Jehonathan author non-byline.; Wilson David author non-byline.; Reade Clare author non-byline.; Gauthier Leslie author non-byline.; Kelly Stephen author non-byline.; Krull Kirsten author non-byline.; Alvarado Kim author non-byline.; Reid Susan author non-byline.; Bhandari Mohit author non-byline.; Dillane Derek author non-byline.; Greene James author non-byline.; Bigam David author non-byline.; Snelgrove Ryan author non-byline.; Buchanan Brian author non-byline.; Rewa Oleksa author non-byline.; Brisebois Ronald author non-byline.; Jomha Nadr author non-byline.; Ritchie Bruce author non-byline.; Reid Sherry author non-byline.; Fairey Adrian author non-byline.; Hrynchyshyn Greg author non-byline.; Shayegan Bobby author non-byline.; Finley Christian author non-byline.; Lim Wendy author non-byline.; Tiboni Maria author non-byline.; Choi David author non-byline.; MacDonald Anne-Marie author non-byline.; Burnette Deanna author non-byline.; Stewart Tom author non-byline.; Farrell Melissa author non-byline.; Goss Carolyn author non-byline.; Quiraishi Faraaz author non-byline.; McIsaac Daniel author non-byline.; Tierney Sarah author non-byline.; Hicks Shawn author non-byline.; Wheeler Kathryn author non-byline.; Robert Josh author non-byline.; McFaul Colleen author non-byline.; Krolczyk Greg author non-byline.; Rao Purnima author non-byline.; Moffett Stephane author non-byline.; Dubois Dan author non-byline.; Code Catherine author non-byline.; Clark Heather author non-byline.; Rousseau Melissa author non-byline.; Gray Catherine author non-byline.; Yelle Dominique author non-byline.; Tawil Youssef author non-byline.; Rashidi Babak author non-byline.; Beckerleg Weiwei author non-byline.; Gupta Shipa author non-byline.; Sundaresan Sudhir author non-byline.; Madore Suzanne author non-byline.; Seely Andrew author non-byline.; Bearnes Reece author non-byline.; Fergusson Dean author non-byline.; Madden Susan author non-byline.; Abou Khalil Jad author non-byline.; Sinclair John author non-byline.; Momtazi Moein author non-byline.; Breau Rodney author non-byline.; Vigil Humberto author non-byline.; Chan James author non-byline.; Ngyuen Freddy author non-byline.; Nicolaou George author non-byline.; Subramani Yamini author non-byline.; Fayad Ashraf author non-byline.; Garg Amit author non-byline.; Vandersluis Cathy author non-byline.; Kearns Glen author non-byline.; Churcher Cheryl author non-byline.; Cormack Carla author non-byline.; Maxwell Brenda author non-byline.; Halabi Johana author non-byline.; Calvin James author non-byline.; Naudie Douglas author non-byline.; Boulton Melfort author non-byline.; Handsor Stephanie author non-byline.; Whittle Heather author non-byline.; Kenning Charlotte author non-byline.; Wang Michael author non-byline.; Khan James author non-byline.; Blake Lori author non-byline.; Dragic-Taylor Sanela author non-byline.; Dyal Leanne author non-byline.; Fernandez Arielle author non-byline.; Koh Peter author non-byline.; Mastrangelo Louise author non-byline.; Liu John author non-byline.; Liu Yan Yun author non-byline.; Tong Wesley author non-byline.; Wilton Heidi author non-byline.;
• Is Part Of: BMJ. Volume 374(2021)
• Publication Date: 2021-09-30
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.n2209
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To 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. Design: Multicentre randomised controlled trial. Setting: 8 acute care hospitals in Canada. Participants: 905 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. Intervention: Participants 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 measures: The 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. Results: All 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. Conclusion: Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. Trial registration: ClinicalTrials.gov NCT04344665 .