Coming soon: recovering at home after an operation?
Imagine that five years from now, you have a major operation and are released from the hospital on the same day. The "faster recovery at home" protocol is implemented. The in-home care nurse has come to the hospital in order to oversee the transition from the hospital to your home. You're still a little groggy from the anesthetic and you and your partner listen to the instructions from the medical staff. You'll be taking the wireless monitoring equipment home with you. "Let's look at it together," says the nurse. A pipe dream? Definitely not! In this blog I show you a little glimpse of what awaits us in the future.
Technology creates massive opportunities. As a researcher at University Medical Center Utrecht and at FocusCura, I have the privilege of working with a great many fantastic Dutch and international health care professionals. Each of them has a unique perspective on the application of telemonitoring patients at home, or monitoring patients in the hospital. This has inspired me to research how we can make health care more pleasant and better for both patients and health care providers.
Released from the hospital sooner
For instance, in University Medical Center Utrecht, in the Netherlands, Professor Van Hillegersberg has overseen the establishment of a "rapid recovery" program for patients with esophageal cancer who have to undergo complex surgery. Usually these patients remain in the hospital for at least two weeks after surgery. The goal of the program is to enable these patients to return home after about seven days!
"Patients sleep better in a familiar environment and can be up and about sooner when they are at home."It is believed that a faster recovery in a familiar environment reduces the chance of complications. It's no stretch to imagine that patients sleep better in a familiar environment and are likely to be up and about sooner when they are at home. They also have a smaller chance of contracting infections (including hospital-acquired infections), developing delirium, or acquiring pneumonia.
Health care professionals outside of the Netherlands are also seeing opportunities to use telemonitoring and improve connections in the health care chain. As a representative of University Health Care Center Utrecht, I have joined with a number of European teaching hospitals to apply for a large grant which focuses on eHealth and the empowerment of the patient. We hope to hear this summer whether we will receive the grant.
Recovering at home after an operation
Dr. David Konrad of Karolinska University Hospital in Stockholm, Sweden, told me about a great example. One of the strategies there is to double the number of surgical procedures performed as outpatient procedures. This means that the patient goes home the same day as the surgery. And they don't limit this to minimally-invasive procedures such as exploratory surgeries, either.
On the one hand, they are doing this to reduce costs, and on the other hand they believe that recovery in the home environment is better for the patient.
But how is it possible to monitor recovery when patients are at home? How can you raise the alarm if a patient's condition worsens? This calls for an entirely different approach than typical in-home care. It requires a safety net using visual and other methods of communication and the use of wearables enabling wireless monitoring. Karolinska University Hospital wants to make further use of these possibilities in the coming years, and I am in wholehearted agreement.
Is the right patient seing sent home?
"It's not just at home - there is a lot that can be improved in the hospital by making better use of technology." And it's not just at home - there is a lot that can be improved in the hospital by making better use of technology. Every day emergency rooms overflow with patients who need help more or less immediately before their condition worsens. In the Netherlands, triage is generally carried out by a nurse, who assigns the patient a color depending on the urgency of their situation.
But is it right that some patients are not admitted to the hospital after visiting the emergency room? Are we making the right choices? When John Welch, a nurse consultant in critical care at University College London Hospital in the UK, told me this, I immediately realized that there were opportunities for improvement here! How can we be sure that these patients will not continue to deteriorate once they get home? You can imagine that home monitoring could be extremely valuable for these patients too.
Giving patients a smart patch
Recently I spoke with Dr. Ryan C. Arnold of the Department of Emergency Services at Christiana Care Health System in Delaware in the USA, where the situation in the emergency room is desperate. Dr. Arnold said that sometimes patients had to wait up to eight hours before they were seen by a doctor. That's why they are currently investigating the possibility of giving these patients a "smart patch," so they can continuously monitor the vital signs and respond to them as needed.
As well as helping them to ensure that patients do not further deteriorate while in the emergency room, this will enable emergency room professionals to better prioritize patients' needs. Who can be sent home right away, who belongs in the nursing ward, and who needs to be admitted to Intensive Care immediately? A patch like this would also collect "evidence" of the vital signs stability - assuming that the patient is being monitored continuously for a few hours - so that a decision could be made on the basis of the vital signs whether or not to send the patient home.
Dr. Taco Blokhuis (trauma surgeon and my co-supervisor), myself, and Prof. Cor Kalkman (anesthesiologist and my supervisor)
Smart personalized alert systems
The examples given above, however, are only possible if we are able to develop smart, personalized alert systems. At present we do not have access to a personalized and "self-learning" algorithm that can analyze a continuous stream of vital signs and integrate them with other information obtained from the patient in real time.
Professor Rademakers of University Hospitals Leuven, in Belgium, told me that he is interested in combining what is called "machine learning" with individual electronic health records, in order to be able to predict various critical events. In the future, similar self-learning algorithms linked to an electronic health record will be able to reliably inform us when a patient needs help, and what personalized treatment will give the best results. That would be an incredible boon!
Communication is key in the health care chain
I believe that all these possibilities will be part of normal health care processes in the near future. Telemonitoring patients at home from the hospital offers a great deal of potential.
"Communication among all the various systems in the entire health care chain, including within the hospital, is essential." But all these possibilities have one thing in common: Communication among all the various systems in the entire health care chain, including within the hospital, is essential. The hospital, the family doctor, the patient, and the informal caregiver will have to actively communicate with one another.
But once this is in place, if you undergo major surgery even within the next five years, it may be that you are sent home with monitoring equipment the very same day!
In any case, it is clear that a lot will change. I am interested in hearing your opinions about the possibilities and challenges!