Domiciliary recovery after medicalization pathway (DREAMPath): a protocol for a prospective observational study to measure patient compliance with remote monitoring following discharge from hospital after major surgery. (Preprint)

Abstract

The incidence of major surgery is on the rise globally, and more than 20% of patients are re-admitted to hospital following discharge from hospital. While in the hospital, patients are monitored as a means of early detection of clinical deterioration, which includes regular measurement of physiological parameters such as blood pressure, heart rate, respiratory rate, temperature, and pulse oximetry. This monitoring ceases upon hospital discharge, as patients are deemed clinically stable. The concept that monitoring after discharge is relevant to detect adverse events occurring in the home setting can be made possible through the development of digital technologies and mobile networks. Smartwatches and other technological devices allow patients to self-measure physiological parameters in the home setting, and Bluetooth connectivity can enable automatic collection of this data to a secure server with minimal input from the patient.

The DREAMPath study is a prospective observational cohort study to measure compliance with a multi-device remote monitoring kit after discharge from hospital following major surgery.

DREAMPath is a single-centre prospective observational cohort study, recruiting 30 patients undergoing major intra-cavity surgery. The primary outcome is to assess patient compliance with wearable and interactive smart technology in the first 30 days following discharge from hospital after major surgery. Secondary outcomes will explore the relation between unplanned healthcare events and physiological data collected in the study, as well as to explore a similar relationship with a daily Patient reported outcome measures (Quality of Recovery 15 score). Secondary outcomes will be analysed using appropriate regression methods. Cardiopulmonary exercise testing data will also be collected to assess correlations with wearable device data.

This manuscript describes the study protocol. Recruitment was halted due to COVID-19 restrictions, and will progress once research staff are back from redeployment.

Digital health solutions have been recently made possible due to technological advances, but urgency in rollout has been expedited due to COVID-19. The DREAMPath study will inform the readers about the feasibility of remote monitoring for a patient group that is at increased of acute deterioration.

The study has ethical approval from South West – Cornwall & Plymouth Research Ethics Committee (REC reference 18/SW/0206). The results of the study will be published in peer-reviewed publications and will be presented at relevant national and international conferences, after patient and public input. The DREAMPath study is registered with ISRCTN (62293620).