Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Surgery

Supervisor

Van Koughnett, Julie Ann

Abstract

Post-operative readmission following colorectal surgery is a common and costly occurrence. Remote health monitoring via mobile applications has the potential to reduce post-operative readmissions by early identification of complications. This intervention depends on patient acceptance and compliance with available technology. The feasibility of home monitoring using automated daily surveys and wound photo uploads, delivered via a mobile health application, was tested in the immediate post-operative period after colorectal surgery. Patient compliance, the association between generated alerts and readmissions, and patient satisfaction were measured. Patient satisfaction was high; 80.5% of patients reported that they felt safer going home knowing that they were monitored and 76.2% of patients reported that they would use the current app for post-operative monitoring again. However, only 37.0% of patients answered the survey at least 80% of the time in the first 2 weeks following discharge. Patient compliance significantly limited the feasibility of post-operative monitoring using our mobile health application.

Summary for Lay Audience

About 11% of patients are readmitted to hospital within one month of colorectal surgery. As technology improves and becomes more accessible, mobile applications may be utilized to monitor patients once they go home from hospital. This has the potential to reduce post-operative readmissions by identifying complications early, which may allow physicians to treat complications on an outpatient basis before they progress to requiring an emergency department visit or admission to a hospital inpatient bed. Identifying complications earlier may also reduce the length of stay if a hospital admission is required for treatment. However, home monitoring requires participation from patients, and it is not known if colorectal surgery patients, who typically are older, will use a mobile application for this purpose. We designed an automated monitoring program consisting of prompted daily surveys and wound photo uploads delivered via a mobile application for post-operative monitoring of colorectal surgery patients following discharge home. We then surveyed patients about their experience with using the mobile application for post-operative monitoring and tested how often they used the mobile application and evaluated whether the alerts generated from patient responses were associated with hospital readmissions and emergency department visits. Most patients reported that they would use the application again for home monitoring following surgery and voiced that they felt safer going home from hospital knowing that they were monitored by the app. However, patients were still unlikely to consistently use the mobile application to report their symptoms to healthcare providers. This limits the healthcare team’s ability to monitor patients through the application and identify patients who are not recovering as expected.

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