The Use of Videoconferencing for Monitoring of Patients Post Urologic Surgery

Study Overview
=================
Brief Summary
-----------------
Our study would be the first randomized study investigating the use of video conferencing via tablet computers versus traditional bedside rounding and its effect on clinical data such as length of stay and complications as well as patient satisfaction. As technology improves, medicine has an obligation to incorporate this technology to improve efficiency and cost-effectiveness. If telerounding is proven to not change outcomes or patient satisfaction, it saves time for the physician during office hours to see more patients or be productive in other ways. Telerounding could be applied in remote areas with a dearth of specialists, allowing these specialists' expertise to reach areas it could not before.

Detailed Description
-----------------
As the healthcare system in America is evolving, doctors are becoming hard-pressed to see and treat more patients in the same amount of time. Over the past century, different forms of telemedicine have allowed doctors to treat patients from a distance, in hopes of increasing access to medical care. Several studies have evaluated the utility of telemedicine in the ICU setting, namely using video-conferencing technology to allow ICU attending physicians to monitor their patients with audio and video media more closely. A prospective, step-wedge study by Lily showed that the use of telemedicine reduced adjusted odds mortality and length of stay in the ICU, as well as several complications such as stress ulcers, deep venous thromboses, and ventilator associated pneumonia. Similar conclusions were found by a meta-analysis in 2011 that looked at 176 tele-ICU articles, which included 41,374 patients. With telemedicine technology, intensivists can theoretically have 24-hour oversight of the ICU from a remote location, possibly being able to oversee multiple units. Although the average urology patient does not require as frequent monitoring as the ICU patient, telemedicine may still play a role in facilitating care for the postoperative urologic patient. In 2004, Ellison el al conducted a study comparing patient satisfaction between patients seen via standard bedside rounds, patients seen via telerounds (as an additional visit) through a laptop computer, and patients only seen via telerounds through a remotely controlled robot. This study showed that telerounding (either of the latter two arms) was associated with greater patient satisfaction in postoperative care, which was found to be linked to physician availability4. In 2007, the same authors conducted a randomized study investigating morbidity, length of stay, and patient satisfaction between standard bedside rounds versus robotic telerounding. There were no differences in outcomes between the two groups. A significant limitation of robotic telerounding is cost. Having and maintaining the robot costs around $60,000 per year, although Gandas et al was able to find a positive financial impact when using the robot in postoperative gastric bypass patients6. However, the development of tablet computers, which have user-friendly video-conferencing applications, has made telemedicine a more affordable tool. In 2012, Kacsmarek et al conducted the first study using tablet computers investigating post-operative patient satisfaction. Their study demonstrated that tablet telerounding can significantly enhance patients' post-operative experience by providing quicker face-to-face access with their attending physician. Our study would be the first randomized study investigating the use of video conferencing via tablet computers versus traditional bedside rounding and its effect on clinical data such as length of stay and complications as well as patient satisfaction. As technology improves, medicine has an obligation to incorporate this technology to improve efficiency and cost-effectiveness. If telerounding is proven to not change outcomes or patient satisfaction, it saves time for the physician during office hours to see more patients or be productive in other ways. Telerounding could be applied in remote areas with a dearth of specialists, allowing these specialists' expertise to reach areas it could not before.

Official Title
-----------------
The Use of Videoconferencing for Monitoring of Patients Post Urologic Surgery

Conditions
-----------------
Urology

Intervention / Treatment
-----------------
* Other: Tele-rounding in post operative care


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients 18 years of age or older Undergo elective Urologic surgery requiring post-operative inpatient stay Exclusion Criteria: Patients under 18 years of age Patients who are unable to provide their own consent Patients who undergo urgent or emergent Urologic procedures who are not already enrolled in the study Patients who do not require an inpatient post-operative stay Patients who are seen on the weekend (Saturday or Sunday)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard<br>Group 1 will consist of patients receiving in-person attending-patient encounters while inpatients. | |
| Experimental: Tele-rounding<br>Group 2 will consist of patients receiving video-conference attending-patient encounters. The intervention is being seen via ipad | Other: Tele-rounding in post operative care<br>* Both groups will receive standard of care. The only difference between these groups would be the physical presence of the attending in the room. Both groups will receive a physical exam with supervision of the attending, one group will have attending in the room and the other will have the attending present via I-pad. In both cases if there was something of concern the attending would step in for the physical exam if needed, regardless of which group they were randomized for.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complication rates |  | 4 years | 
| length of inpatient stay |  | 4 years | 
| number of lab tests ordered |  | 4 years | 
| severity of complications |  | 4 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Additionally patient satisfaction will be looked at based on post-operative questionnaire. | how satisfied they were with seeing provider remotely vs standard of care | 4 years |