Using virtual technology to maximize patient and provider interaction after surgery

This week’s blog is featuring an article written by one of our clients. We are grateful for the opportunity to work together with the Women’s College Hospital as part of their new ambulatory joint replacement surgery program. Patients typically stay in the hospital for up to three days after a knee surgery. This program allows patients to recover from same-day joint replacement surgery from the comfort of their homes while still being connected to their healthcare team.

April 30, 2018

By Atifa Hamir

This article is part three of a four-part series about Women’s College Hospital’s new ambulatory (outpatient) joint replacement surgery program. Part four will shared in next week’s issue of Connect and will focus on ambulatory anesthesia. You can view part one and part two here.

The virtual care component of Women’s College Hospital’s new ambulatory joint replacement surgery program is doing more than just allowing patients to recover from surgery at home. According to Dr. Daniel Cornejo-Palma, general surgery resident and evaluator within the program, this innovative connection is busting healthcare myths about patient and provider interaction, proving that a patient who is at home can have the same number, if not more, of interactions with their care team as they would in hospital.

“A lot of people have this idea that once you’re out of hospital, you no longer have any contact with your providers,” says Dr. Cornejo-Palma. “But the reality for our patients is that with this technology, they’re able to have video calls with their care team, give us regular updates about how they’re feeling and essentially stay in touch with their providers throughout their entire recovery process without ever having to go back to the hospital.”

The ambulatory joint replacement surgery program, which launched earlier this year, allows patients to undergo knee replacement surgery and be discharged home in the same day. Patients continue to receive care at home through a mobile app called aTouchAway by Aetonix. The app, which can be used on any smartphone or tablet device, offers a variety of beneficial features including video calling, real time data sharing and alerts that can be used to remind patients when to take their medication.

Once a patient goes home after their surgery, the app prompts them every two hours to enter information about key health indicators, such as how much pain they are in or if they are experiencing any nausea. Providers then use this information to assess how a patient’s recovery is going as well as to note if a patient’s medication needs to be changed.

“Sometimes patients will say they’re experiencing minimal pain which might trigger us to reduce their pain medication or they may note that they’re experiencing some constipation which tells us they may benefit from a stool softener,” says Dr. Cornejo-Palma. “The information they give us helps us understand their healing process and also helps guide the conversations we have with them in our daily video calls.”

The app is set up to run for three to four days post-op — the same amount of time that patients spend on average in hospital after a knee replacement surgery. For patients who do not have access to such devices or to the internet, the program offers tablets on loan at no cost, which come with the app already downloaded and an existing internet connection. Once the early stage of recovery has been passed, a patient’s care team will assess if the patient is ok to carry on their own or if an extension is required.

“The great thing about this type of technology is that is really helps us enhance the customer service aspect of healthcare,” says Dr. Cornejo-Palma. “The interaction that patients get out of this helps us, as providers, ensure that they’re having the best experience with their care while reinforcing the fact that care doesn’t have to stop at a hospital’s doors.”

Featured image courtesy of Healthline.

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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