(P139) CARDIAC SURGERY VIRTUAL FOLLOW-UP FOR PATIENTS AT HIGH-RISK FOR HOSPITAL READMISSION: DEVELOPMENT OF AN ENHANCED REMOTE TELEMONITORING CARE PLATFORM

Background/Purpose: The complexity of cardiac surgery patients and constraints on healthcare delivery, secondary to the ongoing COVID-19 pandemic, has made it challenging to provide conventional postoperative care. Herein, the University of Ottawa Heart Institute (UOHI) developed an innovative model utilizing advanced telemonitoring to augment postoperative care. Patients are provided a tablet with enabled network access, along with a Bluetooth connected weight scale, blood pressure monitor, oxygen saturation plus heart rate monitor, and/or a thermometer. Patient glucose can also be monitored daily. Patients are prompted each morning to submit a series of best practice questions in the language of their choice, tailored based on prespecified patient needs. A specialized Registered Nurse (RN) monitors these responses remotely and can call for further assessment or coordinate further interventions as needed. Responses are monitored for values outside of prespecified ranges results in an automatic flag to the RN to coordinate patient management and documentation through the Epic electronic medical record. Patients are enrolled in the program for approximately two months postoperatively.

METHODS/RESULTS: Postoperative cardiac surgery patients were enrolled in this program if they had one of the following risk factors for hospital re-admission prior to discharge: 1) >2 kg or above pre-operative weight prior to discharge, 2) new onset arrhythmia which reverted to normal rhythm prior to discharge and are not anticoagulated, 3) class III or IV NYHA or left ventricle ejection fraction ≤35%, or 4) patient deemed high risk for a surgical wound infection. Between June and September 2021, 404 patients underwent cardiac surgery at UOHI, of which 23 were enrolled in this pilot program. Over the course of follow-up, none were re-admitted to hospital and there were no urgent presentations to an emergency department. There were 16 in-person clinic assessments along with 50 telephone interventions. There was a noted decrease in our post-operative length of hospital stay, decrease in readmission rate, and decrease in surgical site infection rate compared to the same quarter the previous year, prior to program existence.

CONCLUSION/IMPLICATIONS FOR PRACTICE: Data is emerging that software applications can engage patients, promote compliance, and capture patient-reported outcome measures. These platforms can increase patient knowledge, decrease anxiety, improve health outcomes, and reduce variation in care. This pilot program is safe and feasible. Early experience suggests virtual patient platforms and monitoring, as well as escalated follow-ups, may mitigate the need for emergency department visits and improve quality of patient and caregiver(s) care. Reference Engelman et al. (2019): https://doi.org/10.1001/jamasurg.2019.1153