iGetBetter’s Remote Physiologic Monitoring Solution for Same Day Discharge (SDD ) Arthroplasty Patients allows Brigham and Women’s Hospital to safely shift Care from Hospital to Home – A Pilot Study
Abstract: The purposes of this pilot study ( conducted by the Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA ) to utilize digital remote monitoring to (a) evaluate the usability and satisfaction of a wireless blood pressure (BP) and heart rate (HR) monitor and (b) determine whether these data can enable safe mobilization at home after same-day discharge (SDD) joint replacement. A population of 23 SDD patients undergoing uni-compartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) were given a cellular BP/HR monitor, with real-time data capture. Patients took three readings after surgery, observing for specific blood pressure decreases, HR increases, or hypotensive symptoms. If any criteria applied, patients followed a hydration protocol and delayed ambulation. Home coaching was also provided to each patient. Patient experience was surveyed, and responses were assessed using descriptive statistics. Of 18 patients discharged (78%), 17 returned surveys, of which 100% reported successful device operation. The mean “ease of use” rating was 8.9/10; satisfaction with home coaching was 9.7/10; and belief that the protocol improved patient safety was 8.4/10. A total of 27.8% (n = 5) had hypotensive readings and appropriately delayed ambulation. Our pilot findings support the feasibility of and confirm the satisfaction with remote monitoring after SDD arthroplasty. All patients with symptoms of hypotension were successfully remotely managed using a standardized hydration protocol prior to safe mobilization.
Same Day Discharge (SDD) after atrhroplasty has emerged as a promising model to optimize both convenience and cost, creating potential savings of 30%, or up to USD 8,500 per patient, driven by decreased surgical floor care, patient meals, inpatient pharmacy, and inpatient physical therapy.
Concurrent to this outpatient shift is a growing interest in web-based platforms for follow-up assessments, patient education, seamless communication, and coaching. Devices to collect real-time biometric data have been introduced into clinical care, measuring blood pressure, oxygen saturation, and blood glucose [13,14]. Wearable trackers can monitor post-operative daily step count , while physician–patient messaging platforms can monitor wound appearance . In SDD arthroplasty, there is significant opportunity to utilize these digital health tools to optimize post-operative recovery for patients at home. For example, hypotension, or “orthostatic intolerance”, after arthroplasty remains a key impediment to mobilization, posing increased risk of falls, prosthesis fractures, and fainting . Digital health tools that could identify hypotensive patients have yet to be introduced to minimize these risks. One of the key aspects of implementing these tools is usability . Before launching initiatives that incorporate digital health technology, appropriate diligence must be taken to understand the patient experience, predict barriers to adoption, and validate efficacy.
The study concludes that findings suggest that there is high feasibility, compliance, and patient satisfaction with remote monitoring after same-day total joint arthroplasty. Nearly 30% of our patients demonstrated post-operative hypotension, as monitored with a cellular device. After delayed mobilization and standardized hydration, these patients were successfully remotely mobilized without complications. After further validation, this protocol may start to bridge the existing gap between convenience and quality in same-day discharge recovery.
iGetBetter offers a complete solution of sensors ( in this case cellular BPM’s ) which do not require any setup at home and the clinical dashboard monitoring patients from anywhere including video / tele-chat communication functionality. The solution is fully HIPAA conform and cost – effective. Please contact us for a demo.
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