Protocol for a proof-of-concept observational study evaluating the potential utility and acceptability of a telemedicine solution for the post-anesthesia care unit

Abstract

Introduction: The post-anesthesia care unit (PACU) is a clinical area designated for patients recovering from invasive procedures. There are typically several geographically dispersed PACUs within hospitals. Patients in the PACU can be unstable and at risk for complications. However, clinician coverage and patient monitoring in PACUs is not well regulated and might be sub-optimal. We hypothesize that a telemedicine center for the PACU can improve key PACU functions. Objectives: The objective of this study is to demonstrate the potential utility and acceptability of a telemedicine center to complement the key functions of the PACU. These include participation in hand-off activities to and from the PACU, detection of physiological derangements, identification of symptoms requiring treatment, recognition of situations requiring emergency medical intervention, and determination of patient readiness for PACU discharge. Methods and analysis: This will be a single center prospective before-and-after proof-of-concept study. Adults (18 years and older) undergoing elective surgery and recovering in two selected PACU bays will be enrolled. During the initial three-month observation phase, clinicians in the telemedicine center will not communicate with clinicians in the PACU, unless there is a specific patient safety concern. During the subsequent three-month interaction phase, clinicians in the telemedicine center will provide structured decision support to PACU clinicians. The primary outcome will be time to PACU discharge readiness determination in the two study phases. The attitudes of key stakeholders towards the telemedicine center will be assessed. Other outcomes will include detection of physiological derangements, complications, adverse symptoms requiring treatments, and emergencies requiring medical intervention. Registration: This trial is registered on clinicaltrials.gov, NCT04020887 (16 th July 2019).

Keywords: Observational Study; Post-Anesthesia Care Unit; Proof-of-Concept; Protocol; Telemedicine.

Conflict of interest statement

No competing interests were disclosed.

Copyright: © 2020 Budelier TP et al.

Figures

Figure 1.. Image of post-anesthesia care unit bay in Barnes-Jewish Hospital with two-way video communication.

Figure 2.. AlertWatch® decision-support software, customized for the post-anesthesia care unit (PACU) environment.

Figure 3.. Overview of data collection methods and outcome measures during the interaction phase of a before-and-after proof-of-concept study for a telemedicine center for the post-anesthesia care unit (PACU).

Figure 4.. Allocation of sample size and post-anesthesia care unit (PACU) layout for proof-of-concept study.