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Hello, my name is Kelly. I am a RN in Clinical Treatment Unit with phase 1 trials.
1. I think this is an interesting concept for post op patients because it is a little crazy how quickly some post op patients leave after surgery. I like in the second article how it “alerted” the team with certain thresholds and the team needed to call back within a certain time frame based on what was happening. I also would’ve liked to seen the device to be able to tell the patient if a symptom is in the red they need to call into clinic or triage.
3. The questions it brought up about my current practice is how this could be incorporated for trial patients. I wonder if there are any sponsors of trials that have considered using this kind of data after patients have started a trial drug. Sponsors have the funds usually and could get this kind of equipment. It would help cut down on the amount of people that have been feeling awful at home and decide to wait until their next appointment to tell the dr what has been going on.
4. I agree with both conclusions of articles that I can see this becoming more of the future of medicine. As we all know, the hospital is not getting any less full and inpatient nurses are not becoming more plenty, so I can imagine only more and more surgeries will look to an outpatient basis when possible.
Jeff-
Another hiccup I can see if the shift would be more towards remote monitoring could be age being a problem with technology. I’m sure a lot elderly population has family or someone to help them after surgery, but for those that don’t, I can see this being a problem. My dad is in his 80’s and got rid of his I phone because it was “too complicated” and went back to a flip phone. I can see trying to record things on a tablet being a headache for some.Michelle-
Yes, I still think the 24-48hr call is definitely important to catch those day 2 complications that were talked about being some of the higher recordings as in, this shouldn’t take the place of a follow up call. I do see the benefit of the longer term follow up post discharge though.Hi! My name is Reena and I currently work in outpatient endoscopy at OSU East Hospital.
1. What knowledge did I gain from the articles? I would have to say that I didn’t learn anything new from the articles. When I worked at the breast center, we would do a lot of remote evaluation of surgical patient’s symptoms and concerns via mychart with pictures in conjunction with phone calls as well as video visits to hopefully alleviate the long drive some of those patients have. I also knew of the biometric evaluations from my father-in -aw after his kidney transplant.
2. Will the knowledge gained from the article change my practice? I would have to say that most likely not as we are more of an outpatient setting for screening colonoscopy.
3. What other questions were raised from the articles? I would say that there was a very small population analyzed for both of these articles and I don’t believe that the compliance with a larger population would stay as high as the 60is% that was reported and will HIPPAA compliance also be maintained?
4. Do I agree or disagree with the articles? I do agree that remote monitoring can be very helpful for patient care if the patients are compliant.
Kelly: I totally agree with you on how quickly surgery patients are discharged from surgeries. I feel like for instance the patients pain control may not be adequately known because they could be still groggy from the anesthesia and not comprehend having the feeling of pain until they get home. I also agree with you that this seems to be the way that the medical field is heading.
Jeff: I have the same thought of you about whether the patient is the reporter or the family member? As many times as I have a family member try to talk for the patient while preparing them for their procedure, I could see them doing the same remotely. This definitely poses problems for being able to actual assess the patient’s true symptoms and concerns.
Jeff I agree the data can be very inaccurate as we see now on remote monitoring. Sometimes it is patient error and sometimes it is the equipment. It is hard to say how accurate it truly is.
Trish I also agree that the physician need to be more involved. I refused to change parameters on a patient as it was from a PCA and than a nurse. NOT an order from a MD or NP. I have a license and something happens to the patient who are they going to look at.
As a few have mentioned- there are treatments that always used to be inpatient and now moving to toward outpatient. There is the other extreme where certain immune checkpoint inhibitors can only be given outpatient and not inpatient (due to billing). These immunotherapies are now moving from infusion to an injection- which again is decreasing the chair time. I know these immunotherapies as an injection are being used in the thoracic oncology (and possibly other disease lines as well).
Kelly- as someone who just had an outpatient surgery it is crazy to see how little time is spent in recovery before being discharged home. My wife told me they came into the room and discussed how the procedure went and lo and behold I have no recollection of that discussion… but because my vital signs were stable and I met parameters for discharge they were prepping me for discharge. Both myself and wife are in the medical field and even the information/ education given on day of surgery added on top of the atmosphere make it hard to remember some things.
That is a really great point Jeff and Kelly- I think of how overwhelming appts can be for myself or family, i think there is definitely a benefit to the telehealth modalities, but it would have to be introduced prior to any sort of treatment or in a way that would be easy for the patient and family to understand and not be overwhelming as another thing to remember.
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