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The Feasibility of a Healthcare Application in the Management of Patients Undergoing a Radical Cystectomy.

Journal of Urology 2019 January 26
PURPOSE: Patients who undergo radical cystectomy for bladder cancer are at high risk of complications and readmissions. Studies indicate insufficient preoperative education and perioperative monitoring. The aim of this study is to demonstrate the feasibility of implementing a health care application to provide more patient education and more thorough monitoring perioperatively.

MATERIALS/METHODS: Participants undergoing radical cystectomy with home Wi-Fi access were recruited for this pilot trial. Each subject was provided a tablet preloaded with the m.Care healthcare application, an accelerometer, and vital sign equipment. Participants were asked to watch educational videos, use the accelerometer provided, and perform vital sign monitoring.

RESULTS: In one year, twenty participants enrolled, and fifteen participants completed the study. The most frequently viewed videos were "Ileal conduit versus Neobladder" and "Comprehensive Care Pathway." All participants used the accelerometer and 60% kept up with syncing their data regularly. The average step-count preoperatively was 5679 reflecting a sedentary population. Step counts decreased during the inpatient stay (1351) and trended towards baseline during the postoperative period (3156). Vital signs were recorded on 85% of assigned days and generated 33 triggers for intervention. While the majority of triggers led to repeat assessment, education, and encouragement, four participants underwent outpatient management (cultures, IV fluids, antibiotics, or dronabinol prescription) without the need for hospital readmission.

CONCLUSION: Providing more education and monitoring perioperatively is feasible using a healthcare application. Testing the extent to which implementation of use will improve patient triaging and reduce readmissions is warranted.

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