Post Op Home Monitoring After Joint Replacements
Condition: Total Knee Replacement; Total Hip Replacement
Study type: Interventional

Summary: 
      The investigators propose to deploy an interactive device to monitor the patient's recovery
      and vital signs at home after joint replacements. These will be early discharge patients on
      the same day or the next morning. The goal will be to support early discharges by creating a
      safe, controlled, and monitored environment at home.
    

Detailed description: 
      1. Background and rationale. According to the latest Canadian Census, seniors aged 65 or
           over have increased in number by 609,810 from 13.7% of the population in 2006 to
           4,945,060, or 14.8% in 2011. In Ontario, in 2001, there were 8,000 total hip
           replacements (THR) and 11,000 total knee replacements (TKR); in 2016, the projection is
           20,000 THR and 54,000 TKR, assuming age-specific rates remain the same(1). At The Ottawa
           Hospital (TOH), we have already witnessed the pressure on bed management due to the
           increasing case volume. As a solution, we have successfully organized early discharges
           (EDc), on the same day, in select patients after unicompartment arthroplasty in order to
           reduce the length of stay (LOS)(2). Since then, we have discharged select major joint
           replacement patients on the same day or after overnight stay on multimodal analgesia.

           A remote patient monitoring interactive system for chronic disease care. This monitor
           allows telephone or wireless connectivity with the patient and is equipped with NIBP
           (non-invasive blood pressure), HR (heart rate), and SpO2 (pulse oximetry) measurements
           that the patient or a caretaker could use at home. It generates regular reminders for
           the patient to measure his/her NIBP, HR, glucose levels if appropriate and SpO2 as well
           as answer a scripted questionnaire for pain. Results and alerts are then transmitted to
           the healthcare team. The system has never been deployed in an acute care or post-op
           environment. We propose therefore to conduct a feasibility study on early discharge
           patients after unicompartment or total joint replacements, deploying the Telus
           interactive RPM with our existing early discharge care path.

        2. Methods This is a feasibility study to allow planning for a larger future study to prove
           the above hypothesis.

      A sample size of 54 is sufficient to yield a one-sided 95% confidence interval estimate
      around our primary outcome measure (proportion of successful transmissions) with a lower
      bound exceeding the cutpoint for feasibility of 90%, assuming a proportion of 95% successful
      transmission. Recruitment will be at the orthopedic clinics, using the approved OHRI "Consent
      for Personal Health Information Review for Research Purposes" obtained through a member of
      the circle of care. Informed consent will be obtained at the General Pre-Admission Unit (PAU)
      by the research assistant after eligibility has been determined. A screening process for
      unicompartment knee arthroplasty and care path for same day discharge is currently in place.
      For this study, care paths for same day / early discharge for total hip and knee arthroplasty
      will be confirmed. Theses care paths will include home visits by nursing and physio through
      the Community Care Access Centre (CCAC).

      Patients who satisfy the early discharge criteria will be approached. After informed consent
      the use of the remote patient monitoring device will be demonstrated . prior to discharge,
      after ensuring that the patient has achieved the defined outcomes of the care path, the
      functionalities of the device will be reviewed with the patient and care-taker. The patient
      will be given the monitor to bring home and set up. If required a member of the study team
      will assist you with the set up and use of the device This may require a home visit. CCAC
      visit will be as outlined in the care path and at the latest by the next day. Monitoring will
      be continued for 4 days at home.The system will be repatriated to TOH for cleaning and
      preventative maintenance.

      Post-operative complications will be documented at Day 4 and with a followup phone call at 30
      days, including POMI (postoperative myocardial infarction),CHF (congestive heart failure),DVT
      (deep vein thrombosis), PE (pulmonary embolism)pneumonia, cardiac dysrhythmia requiring
      treatment, wound dehiscence, and surgical site infections (SSI). The patient satisfaction
      questionnaire will include concerns with the RPM as well as the healthcare team response and
      will be completed by the patient using the patient monitoring system within 48 hours after
      the monitoring is completed.A followup phone call will occur at Day 30. Results from this
      feasibility study will be used to plan a future large-scale randomized controlled trial to
      evaluate effectiveness and safety of the above.
    

Intervention name(s): remote patient monitoring (Telus RPM)
Intervention type(s): Device
Intervention description(s): All joint replacement patients in the study will use the same type of remote patient monitor for 4 days post operation at home.
Other intervention name(s): Telus RPM
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: knee replacement; hip replacement; patient monitor