Use of Robotic Telerounding After Operative Procedures
Condition: Post-Operative in-Patients
Study type: Interventional

Summary: 
      This research is being done to test a two-way video system mounted on top of a robot. After
      surgery the act of seeing and evaluating patients in the hospital is called standard
      "rounding". This research study will allow doctors to see and speak with their patients using
      the two-way video system - "telerounding", during their stay at the hospital. The purpose of
      this study is to assess the safety of telerounding during a patients hospital stay.

      Our hypothesis is that post-operative morbidity and the time to identification of
      post-operative morbidity will not vary with this new method of rounding.
    

Detailed description: 
      The Department of Urology and the University of California, Davis has made a major commitment
      to the development of novel applications of advanced telecommunications to the practice of
      modern health care.

      Telemedicine has become an increasingly important although underutilized component of modern
      healthcare. To date, telemedicine has been limited to physician education in the form of
      video conferencing for seminars, and to providing specialist consultation in rural medical
      clinics. However, given the recent technological advances in wireless Internet capabilities
      and the decreasing cost of these services, we see alternate capabilities for this technology.

      As is well known, the act of seeing patients at the bedside while they are hospitalized is
      called "rounding." For patients that have undergone an elective minimally invasive surgical
      procedure, such as laparoscopy, hospital stays have become brief events. In fact, the
      convalescence from these procedures is measured in days rather than weeks. For most
      individuals, the hospitalization is necessary to allow for the delivery of IV fluids, to
      check serum chemistries and blood counts while waiting for bowel function to return. To this
      end, the physician bedside visit is in large part an opportunity to relay information
      regarding the progress of recovery based on objective laboratory and vital sign measures.

      We have developed a video-conferencing system that allows physicians to see and speak with
      their patients from a remote location (telerounding). In a randomized trial of telerounds
      versus standard rounds conducted while I was a Urology Fellow at Johns Hopkins, we examined
      the impact of this form of post-operative management on elements of patient satisfaction with
      their hospitalization. We found that patients managed with the telerounding system gave
      higher ratings for their hospitalization than those managed by standard bedside rounds. One
      such application is the use of teleconferencing as a primary mode of post-operative care
      management (telerounding). In a prior study we performed at Johns Hopkins, patients expressed
      higher ratings of satisfaction when the telerounding system was added to usual post-operative
      care. However, that project was not designed to address the issue of patient safety.

      The purpose of the study is to assess if there is a difference in patient outcomes when
      post-operative patients are managed with "standard rounding" versus "telerounding". Our
      primary outcome measure is time to recognition of post-operative morbidity. The telerounding
      system will consist of a wireless Internet-based videoconferencing device mounted on a
      remotely controlled service robot.

      This study will be a prospective, randomized trial. The study population will consist of
      patients scheduled for laparoscopic radical prostatectomy for the treatment of prostate
      cancer.

      Patients will undergo their scheduled surgery and receive the usual perioperative and
      immediate post-operative care delivered by the recovery room staff. Once transferred to the
      patient floor, intervention patients will communicate with their attending physician on a
      daily basis via the teleconferencing system. Intervention patients will not be seen at the
      bedside by their attending surgeon. The hospital and resident staff will provide routine
      daily bedside care. Patients may remove themselves from the study at any time by requesting a
      bedside visit by the attending physician. The intervention will conclude with either the
      hospital discharge or identification of a major post-operative morbidity. Intervention arm
      participants will then participate in a series of focus groups. These sessions will serve as
      the basis for a detailed qualitative analysis of patient perceptions of this technology and
      its role in future health care.
    

Intervention name(s): InTouch Telerounding Robot
Intervention type(s): Device
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Educational/Counseling/Training
Keywords: nephrectomy; Safety; Laparoscopy; telerounding; prostatectomy