Ottawa Heart Institute expands remote monitoring to surgical patients

The University of Ottawa Heart Institute (UOHI) operates one of Canada’s biggest remote monitoring programs for acute care patients. The long-running program – started in 2005 – has reduced hospital readmissions for Heart Failure (HF) patients by 54 percent, all by closely monitoring them at home using electronic equipment.

This year, the UOHI added discharged surgical patients to the program. To help monitor them at home, it has trained patients to use tablet computers to take pictures of their wounds, and to send them back to the nurses at the medical centre for review.

“If the wound is looking serious, we can contact them and coach them on what to do,” said Erika MacPhee, vice president, Clinical Operations. “And if it looks like it’s getting really serious, we can intervene. We can bring them in.”

In this way, through virtual visits and monitoring, the hospital can continue to provide top-quality care while patients get to go home earlier.

As MacPhee observed, lengths of stay in hospitals are steadily decreasing, with patients being discharged surprisingly early. For example, a patient who has undergone a Transcatheter Aortic Valve Replacement may leave hospital in just 24 hours, and a bypass patient may return home in just five days.

Not only are the early discharges freeing up hospital beds, they’re also welcomed by the patients themselves. After all, hospitals are noisy places with continuous interruptions, so it’s hard for patients to rest and recover. Home is much more relaxing.

As well, cardiac patients are commonly depressed after surgery – many of their favourite foods have been taken away from them as they learn to reshape their behaviours. Going home to their loved ones is often a big relief and a major compensation for what’s been taken away.

Still, when they’re discharged, they’re frail and need supervision. That’s where electronic patient monitoring is a boon.

Earlier this year, the UOHI changed it’s electronic monitoring to equipment that’s produced by Cloud DX of Kitchener, Ont. The previous supplier declared that it would no longer support Canadian customers, and a review of existing options found that Cloud DX was the best alternative.

Using the Cloud DX kits, the UOHI nurses can monitor a patient’s weight, oxygen, blood pressure, pulse and temperature. As well, the patients are asked to report on a few questions each day, revolving around how they’re feeling.

“We don’t ask too many questions, because we don’t want them losing interest,” said MacPhee. “We want them reporting every day, so the questions are well designed.”

The Cloud DX tablet is simple to use, with large buttons on the screen for patients to press. The vital signs devices are connected to it by Bluetooth, and the communication with the University of Ottawa Heart Institute is by cellular network or wi-fi. It’s easy for the patients to collect and send their data daily.

And of course, using the tablet that’s part of the kit, patients can also capture photos of wounds.

But as MacPhee quips, the Samsung tablets are locked and dedicated to telehealth applications. “You can’t run Netflix on it, just Cloud DX.”

Three nurses at the UOHI are able to monitor over 400 heart failure patients annually, and another nurse is monitoring the newer surgical monitoring program, with about 35 patients each month.

The daily results are viewed at a station at the UOHI, and trouble spots are recognized immediately with red alerts. As well, the nurses can trend the information, so they see good news or problems in the works.

“It’s very simple for us to use,” said MacPhee. “Cloud DX created an interface that gives us just what is essential.”

Even if everything on a patient’s record is “green,” a nurse will still contact the patient two to three times a week.

It’s important to get the “human” feedback and to stay in the loop with the patient. The conversation can be supported by the data that’s sent each day, so the nurse can ask about things like weight and blood pressure.

“A lot of nursing attention is needed,” said MacPhee.

If they see that a patient’s weight has been increasing, for example, they can ask over the phone what’s been going on.

“In many cases, people will let a little loose over the weekend,” she said. “They might not realize the effect their food will have on their sodium levels.” She said a lot of coaching is required to get patients on-track with healthier living.

The UOHI also helps regional hospitals manage their remote monitoring programs, as the UOHI is the sole provider in the region for cardiovascular services. Many patients come into Ottawa for their cardiac care. The UOHI has been providing monitoring services to patients of 16 area hospitals.

“It allows us to provide them with care closer to home,” said MacPhee. Those hospitals have been using the previous vendors’ equipment, but the plan is now to switch them over to Cloud DX, as well.

Regarding compliance with the telemonitoring equipment and reporting daily, MacPhee said it’s unusual for patients not to cooperate. The gear is easy to use, and it’s in their interests to participate in the daily reporting.

If there are any participation issues, Cloud DX co-founder and CEO Robert Kaul said the company lends a hand: “We stand out in RPM by offering our customers full support for patient compliance, which means the nurses don’t have to worry about compliance calls. We reduce their workflow interruptions and increase both worker and patient satisfaction.”