Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2017; 9(9): 193-199
Published online Sep 27, 2017. doi: 10.4240/wjgs.v9.i9.193
Development of a telehealth monitoring service after colorectal surgery: A feasibility study
Damian D Bragg, Helena Edis, Sian Clark, Simon L Parsons, Binoy Perumpalath, Dileep N Lobo, Charles A Maxwell-Armstrong
Damian D Bragg, Helena Edis, Sian Clark, Simon L Parsons, Binoy Perumpalath, Dileep N Lobo, Charles A Maxwell-Armstrong, Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
Author contributions: Bragg DD contributed to conception and design of the work, data collection, drafting of manuscript, final approval, accountability for the manuscript; Edis H contributed to design of the work, data collection, final approval, accountability for the manuscript; Clark S and Perumpalath B contributed to design of the work, final approval, accountability for the manuscript; Parsons SL contributed to design of the work, critical revision of manuscript, final approval, accountability for the manuscript; Lobo DN contributed to design of the work, data interpretation, critical revision of manuscript, final approval, accountability for the manuscript; Maxwell-Armstrong CA contributed to design of the work, data interpretation, critical revision of manuscript, final approval, accountability for the manuscript, overall supervision.
Institutional review board statement: The study was reviewed by the University of Nottingham ethical committee chairman. Formal ethical board approval was deemed unnecessary for this service improvement.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors has a conflict of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at dileep.lobo@nottingham.ac.uk. Participants gave informed consent for anonymized data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dileep N Lobo, Professor, Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom. dileep.lobo@nottingham.ac.uk
Telephone: +44-115-8231149 Fax: +44-115-8231160
Received: January 27, 2017
Peer-review started: February 8, 2017
First decision: March 9, 2017
Revised: August 23, 2017
Accepted: September 3, 2017
Article in press: September 4, 2017
Published online: September 27, 2017
Abstract
AIM

To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery, within an enhanced recovery protocol.

METHODS

Florence (FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions, such as hypertension, using text-messaging. New algorithms were designed to monitor the well-being, basic physiological observations and any patient-reported symptoms, and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge. All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback.

RESULTS

Over a four-week period, 16 out of 17 patients used the FLO telehealth service at home. These patients did not receive telephone follow-up at three days, as per our standard protocol, unless they reported being unwell or did not make use of the technology. Three patients were readmitted within 30 d, and two of these were identified as being unwell by FLO prior to readmission. No adverse events attributable to the use of the technology were encountered.

CONCLUSION

The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible. The use of this technology may assist in the early recognition and management of complications after discharge.

Keywords: Telehealth, Remote monitoring, Colorectal surgery, Telephone follow up, Readmission

Core tip: Remote follow-up in the immediate post-discharge period utilising telehealth is feasible, and may help identify patients at risk of developing complications sooner, leading to earlier proactive management.