EP523 - Colorectal "Virtual Hospital": A Novel Outpatient Care Pathway To Advance Surgical Care

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Purpose/Background: The COVID-19 pandemic magnified pre-existing problems in our health care system such as over-capacity hospitals and extended surgical wait times. This served as a catalyst to conserve in-hospital resources and expedite care by expanding day surgery criteria to patients who would otherwise be admitted post-operatively. “Virtual Hospital” (VH), established in the Edmonton Zone in 2018, provided the infrastructure to deliver comprehensive outpatient care via telephone, video conference, and remote automated monitoring (RAM). We conducted a prospective observational study to determine safety and feasibility of a day surgery pathway for patients who were previously admitted following surgery. By utilizing VH, we aim to improve patient experience, circumvent case cancellations due to bed shortages, and reduce hospital length of stay, readmissions, or emergency visits.

Methods/Interventions: Patients were selected based on the following inclusion criteria: age over 18, undergoing minimally invasive colorectal surgery, 1-3 day expected length of in-hospital stay, residing in the Edmonton Metro area, patient or caregiver able to communicate with VH team, and functionally able to be at home. Consented participants met with the VH team 1-2 weeks pre-operatively to receive RAM equipment (Cloud DX) education and analgesic and antiemetic prescriptions. Post-operative care included: VH nurse telehealth visits, in-person assessments by paramedics (Mobile Integrated Health Field Team), post-operative day (POD) 1 and 3 bloodwork (CBC, electrolytes, creatinine, CRP), and Cloud DX vital signs (heart rate, blood pressure, temperature, oxygen saturation). All patient progress was reviewed daily with the VH “surgeon-on-call”. Primary outcome measures include: return to hospital, bowel function (flatus, bowel movements), nausea, vomiting, and pain scores.

Results/Outcomes: From March 2021 to October 2023, 51 patients were enrolled. Surgeries included ileostomy closure (69%), laparoscopic right hemicolectomy/ileocolic resection (27%), stoma revision (2%) and laparoscopic small bowel resection (2%). Four patients did not meet same day discharge criteria and were admitted post-operatively. Five patients required readmission during follow up. Average number (SD) of total VH visits was 12.2 (5.0). Average pain scores (SD) out of 10 on POD 1, 2, and 3 were 5.3 (2.2), 4.1 (2.5), and 3.9 (2.6) respectively. By POD 3, 90% of patients were passing flatus, and 88% had bowel movements. Nausea was most prevalent on POD 2 (33%). Emesis was infrequent, occurring in 10% of patients on POD 1 and 8% of patients on POD 2 and 3.

Conclusion/Discussion: Virtual hospital provides safe outpatient care to patients undergoing minimally invasive surgery while decreasing utilization of hospital resources. Clinical care was accessible in-person and virtually, and patients requiring inpatient care were identified in a timely manner.