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

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
.