Clinical trial NCT02771431: The Use of Videoconferencing for Monitoring of Patients Post Urologic Surgery
Official title: The Use of Videoconferencing for Monitoring of Patients Post Urologic Surgery
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Urology
Lead sponsor: Northwell Health
Sponsor class: OTHER
First posted: 2016-05-13
Enrollment: 107
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

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.

Eligibility criteria: Inclusion Criteria:

1. Patients 18 years of age or older
2. Undergo elective Urologic surgery requiring post-operative inpatient stay

Exclusion Criteria:

1. Patients under 18 years of age
2. Patients who are unable to provide their own consent
3. Patients who undergo urgent or emergent Urologic procedures who are not already enrolled in the study
4. Patients who do not require an inpatient post-operative stay
5. Patients who are seen on the weekend (Saturday or Sunday)

Primary outcomes:
measure: Complication rates
timeFrame: 4 years
measure: length of inpatient stay
timeFrame: 4 years
measure: number of lab tests ordered
timeFrame: 4 years
measure: severity of complications
timeFrame: 4 years
Secondary outcomes:
measure: Additionally patient satisfaction will be looked at based on post-operative questionnaire.
timeFrame: 4 years
Other outcomes:
Locations:
city: New Hyde Park
country: United States
facility: North Shore LIJ
state: New York
Study officials:
affiliation: Physician
name: Manish Vira, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Strehle EM, Shabde N. One hundred years of telemedicine: does this new technology have a place in paediatrics? Arch Dis Child. 2006 Dec;91(12):956-9. doi: 10.1136/adc.2006.099622.
citation: Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, Chandler MW, Irwin RS; University of Massachusetts Memorial Critical Care Operations Group. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA. 2011 Jun 1;305(21):2175-83. doi: 10.1001/jama.2011.697. Epub 2011 May 16.
citation: Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch Intern Med. 2011 Mar 28;171(6):498-506. doi: 10.1001/archinternmed.2011.61.
citation: Ellison LM, Pinto PA, Kim F, Ong AM, Patriciu A, Stoianovici D, Rubin H, Jarrett T, Kavoussi LR. Telerounding and patient satisfaction after surgery. J Am Coll Surg. 2004 Oct;199(4):523-30. doi: 10.1016/j.jamcollsurg.2004.06.022.
citation: Ellison LM, Nguyen M, Fabrizio MD, Soh A, Permpongkosol S, Kavoussi LR. Postoperative robotic telerounding: a multicenter randomized assessment of patient outcomes and satisfaction. Arch Surg. 2007 Dec;142(12):1177-81; discussion 1181. doi: 10.1001/archsurg.142.12.1177.
citation: Gandsas A, Parekh M, Bleech MM, Tong DA. Robotic telepresence: profit analysis in reducing length of stay after laparoscopic gastric bypass. J Am Coll Surg. 2007 Jul;205(1):72-7. doi: 10.1016/j.jamcollsurg.2007.01.070.
citation: Kaczmarek BF, Trinh QD, Menon M, Rogers CG. Tablet telerounding. Urology. 2012 Dec;80(6):1383-8. doi: 10.1016/j.urology.2012.06.060.