Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart Angel™ app and an original web platform for patients following outpatient surgery: a prospective observational pilot study

Thierry Chevallier, Gautier Buzancais, Bob-Valéry Occean, Pierre Rataboul, Christophe Boisson, Natacha Simon, Ariane Lannelongue, Noémie Chaniaud, Yann Gricourt, Jean-Yves Lefrant, Philippe Cuvillon, Thierry Chevallier, Gautier Buzancais, Bob-Valéry Occean, Pierre Rataboul, Christophe Boisson, Natacha Simon, Ariane Lannelongue, Noémie Chaniaud, Yann Gricourt, Jean-Yves Lefrant, Philippe Cuvillon

Abstract

Background: Remote monitoring of mean arterial blood pressure (MAP), heart rate (HR) or oxygen saturation (SpO2) remains a challenge in outpatient surgery. This study evaluates a new digital technology (Smart Angel™) for remotely monitoring hemodynamic data in real time: data transmitted from the patient's home to a central server, using a dedicated web-based software package.

Methods: Adults scheduled for elective outpatient surgery were prospectively enrolled. In the first 5 postoperative days, patients completed a self-report questionnaire (pain, comfort, nausea, vomiting) and recorded SpO2, HR and MAP via two wireless Bluetooth monitors connected to a 4G tablet to transmit the data to a website, in real time, using Smart Angel™ software. Before transmission to the website, these data were also self-reported by the patient on a paper form. The primary outcome was the proportion of variables (self-monitored physiological data + questionnaire scores) correctly transmitted to the hospital via the system compared with the paper version. On Day 5, a system usability scale survey (SUS score 1-100) was also attributed.

Results: From May 2018 to September 2018, data were available for 29 out of 30 patients enrolled (1 patient was not discharged from hospital after surgery). The remote monitoring technology recorded 2038 data items (62%) compared with 2656 (82%) items recorded on the paper form (p = 0.001). The most common errors with the remote technology were software malfunctioning when starting the MAP monitor and malfunctioning between the tablet and the Bluetooth monitor. No serious adverse events were noted. The SUS score for the system was 85 (68-93) for 26 patients.

Conclusion: This work evaluates the ability of a pilot system for monitoring remote physiological data using digital technology after ambulatory surgery and highlights the digital limitations of this technology. Technological improvements are required to reduce malfunctioning (4G access, transmission between apps).

Trial registration: ClinicalTrials.gov ( NCT03464721 ) (March 8, 2018).

Keywords: Ambulatory surgery; Device; Remote monitoring; Usability.

Conflict of interest statement

“The authors declare that they have no competing interests”.

Figures

Fig. 1
Fig. 1
(All illustrations and images provided by the author and never published elsewhere): a: System overview: Data are transmitted from the patient’s home to a central server, using a dedicated web-based software package. The data are subsequently processed and presented to health care workers at the hospital. b: Range of MAP, SpO2, HR for the remote monitoring. c: Overview of app and monitor: remote wireless monitoring (a), patient with monitors (b) and tablet screen (c) (Illustration provided by the author and never published elsewhere). a: Monitor, tablet and bag. 1: Heart rate and SpO2 monitor. 2: MAP monitor. 3: Cables for USB connection or battery. 4: Tablet. 5: Dedicated briefcase. b: Connected monitor positioned by the patients themselves and tablet used by patients. c: App screen and questionnaires (showing pain on the NRS)
Fig. 2
Fig. 2
a: Patient’s written recordings. b: Patient’s remote monitoring

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Source: PubMed

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