The Post discharge after surgery Virtual Care with Remote Automated Monitoring technology (PVC-RAM) Trial is a multicentre, parallel group, superiority, randomized controlled trial to determine the effect of virtual care with remote automated monitoring (RAM) technology compared to standard care on days alive at home during the 30-day follow-up after randomization, in adults who have undergone semi-urgent (e.g., oncology), urgent (e.g., hip fracture), or emergency (e.g., ruptured abdominal aortic aneurysm) surgery. It will also determine, during the first 30 days, the effect of virtual care with RAM technology on several secondary outcomes, including: 1. hospital re-admission; 2. emergency department visit; 3. urgent-care centre visit; 4. acute-hospital care (i.e., a composite of hospital re-admission and emergency department or urgent-care centre visit) 5. brief acute-hospital care (i.e., acute-hospital care that lasts
Other: Virtual Care and Remote Automated Monitoring
Patients will measure daily vitals (blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, weight) with remote monitoring technology and complete recovery surveys daily in home after discharge from hospital. Patients will interact with a virtual nurse daily on days 1-15 and every other day from days 16-30. If the patient's RAM measurements exceed predetermined thresholds, the patient reports specific symptoms (e.g., shortness of breath), a drug error is identified, or the virtual nurse has concerns about the patient's health that they cannot resolve, the virtual nurse will escalate care to a pre-assigned and available physician. Physicians will add or modify treatments as needed, and if required, they will have the patient come to an outpatient facility for evaluation or management. Via secure video or text messaging, patients will also have access to a virtual nurse at night, for any urgent issues.
Inclusion Criteria:
1. are ≥40 years of age;
2. have undergone same-day or inpatient semi-urgent, urgent, or emergency surgery and are
being discharged home or are within 24 hours after discharge home, as long as they
have not had acute-hospital care since their discharge; and
3. provide informed consent to participate.
Exclusion Criteria:
1. underwent same-day surgery and the surgeon or anesthesiologist believe the case
reflects a traditional same-day surgery case with a low likelihood of needing
acute-hospital care;
2. went to rehabilitation or convalescent care for more than 7 days after undergoing
surgery;
3. are unable to communicate with research staff, complete study surveys, or undertake an
interview using a tablet computer due to a cognitive, language, visual, or hearing
impairment; or
4. reside in an area without cellular network coverage and no home Wi-Fi.
University of Alberta Hospital
Edmonton, Alberta, Canada
The Ottawa Hospital
Ottawa, Ontario, Canada
Hamilton General Hospital
Hamilton, Canada
Juravinski Hospital
Hamilton, Canada
St. Joseph's Healthcare Hamilton
Hamilton, Canada
Kingston Health Sciences Centre
Kingston, Canada
London Health Sciences Centre
London, Canada