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Journal Description

JMIR Perioperative Medicine (JPOP, Editor-in-chief: John F. Pearson MD, Harvard Medical School) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2018: 4.945), focusing on technologies, medical devices, apps, engineering, informatics and patient education for perioperative medicine and nursing, including pre- and post-operative education, preventative interventions and clinical care for surgery and anaesthesiology patients, as well as informatics applications in anesthesia, surgery, critical care and pain medicine.

As open access journal we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

During a limited period of time, there are no fees to publish in this journal. Articles are carfully copyedited and XML-tagged, ready for submission in PubMed Central.

Be a founding author of this new journal and submit your paper today!

 

Recent Articles:

  • Source: flickr; Copyright: BCcampus_News; URL: https://www.flickr.com/photos/61642799@N03/46727772805/in/photolist-2ecb3Tg-Tx5D8b-6sBcWv-gyCJnX-pxLBGK-6pqm8z-MezT4s-garVYF-Y3Bt8N-5uNVyi-25MjKQA-66CqCV-eiWFJ4-236hzey-7siBpQ-sMg9L-27Hr9wd-G24b1M-GbVoSK-Agbfht-nhsKfi-Vjfu85-Wj5vGU-A8VXZY-JndMxA-g19Qj4-21; License: Public Domain (CC0).

    Impact of an Intensive Care Information System on the Length of Stay of Surgical Intensive Care Unit Patients: Observational Study

    Abstract:

    Background: The implementation of computerized monitoring and prescription systems in intensive care has proven to be reliable in reducing the rate of medical error and increasing patient care time. They also showed a benefit in reducing the length of stay in the intensive care unit (ICU). However, this benefit has been poorly studied, with conflicting results. Objective: This study aimed to show the impact of computerization on the length of stay in ICUs. Methods: This was a before-after retrospective observational study. All patients admitted in the surgical ICU at the Rouen University Hospital were included, from June 1, 2015, to June 1, 2016, for the before period and from August 1, 2016, to August 1, 2017, for the after period. The data were extracted from the hospitalization report and included the following: epidemiological data (age, sex, weight, height, and body mass index), reason for ICU admission, severity score at admission, length of stay and mortality in ICU, mortality in hospital, use of life support during the stay, and ICU readmission during the same hospital stay. The consumption of antibiotics, biological analyses, and the number of chest x-rays during the stay were also analyzed. Results: A total of 1600 patients were included: 839 in the before period and 761 in the after period. Only the severity score Simplified Acute Physiology Score II was significantly higher in the postcomputerization period (38 [SD 20] vs 40 [SD 21]; P<.05). There was no significant difference in terms of length of stay in ICU, mortality, or readmission during the stay. There was a significant increase in the volume of prescribed biological analyses (5416 [5192-5956] biological exams prescribed in the period before Intellispace Critical Care and Anesthesia [ICCA] vs 6374 [6013-6986] biological exams prescribed in the period after ICCA; P=.002), with an increase in the total cost of biological analyses, to the detriment of hematological and biochemical blood tests. There was also a trend toward reduction in the average number of chest x-rays, but this was not significant (0.55 [SD 0.39] chest x-rays per day per patient before computerization vs 0.51 [SD 0.37] chest x-rays per day per patient after computerization; P=.05). On the other hand, there was a decrease in antibiotic prescribing in terms of cost per patient after the implementation of computerization (€149.50 [$164 USD] per patient before computerization vs €105.40 [$155 USD] per patient after computerization). Conclusions: Implementation of an intensive care information system at the Rouen University Hospital in June 2016 did not have an impact on reducing the length of stay.

  • The telePORT app providing an overview of the cases running in the main operating rooms. Source: BC Children's Hospital Research Institute; Copyright: BC Children's Hospital Research Institute; URL: https://periop.jmir.org/2019/2/e13559; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).

    Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study

    Abstract:

    Background: In the perioperative environment, a multidisciplinary clinical team continually observes and evaluates patient information. However, data availability may be restricted to certain locations, cognitive workload may be high, and team communication may be constrained by availability and priorities. We developed the remote Portable Operating Room Tracker app (the telePORT app) to improve information exchange and communication between anesthesia team members. The telePORT app combines a real-time feed of waveforms and vital signs from the operating rooms with messaging, help request, and reminder features. Objective: The aim of this paper is to describe the development of the app and the back-end infrastructure required to extract monitoring data, facilitate data exchange and ensure privacy and safety, which includes results from clinical feasibility testing. Methods: telePORT’s client user interface was developed using user-centered design principles and workflow observations. The server architecture involves network-based data extraction and data processing. Baseline user workload was assessed using step counters and communication logs. Clinical feasibility testing analyzed device usage over 11 months. Results: telePORT was more commonly used for help requests (approximately 4.5/day) than messaging between team members (approximately 1/day). Passive operating room monitoring was frequently utilized (34% of screen visits). Intermittent loss of wireless connectivity was a major barrier to adoption (decline of 0.3%/day). Conclusions: The underlying server infrastructure was repurposed for real-time streaming of vital signs and their collection for research and quality improvement. Day-to-day activities of the anesthesia team can be supported by a mobile app that integrates real-time data from all operating rooms.

  • A Panda app notification prompting parents to give their child medication. Source: Image created by the Authors; Copyright: The Authors; URL: https://periop.jmir.org/2019/2/e12305; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility

    Abstract:

    Background: Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child’s pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting. Objective: The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents’ satisfaction. Methods: Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child’s pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user’s adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app’s ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round. Results: Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30% (interquartile range [IQR] 22%-33%) of alerts within 1 hour in round 1, and subsequently to median 60% (IQR 44%-64%) in round 2 and median 64% (IQR 56%-72%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts. Conclusions: It is feasible for parents or guardians to use Panda at home to manage their child’s medication schedule and track their pain. Simple modifications to the app’s alert sounds and user interface improved response times.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/close-up-girl-using-laptop-wooden-desk_2627429.htm; License: Licensed by JMIR.

    Children’s Use of and Experiences With a Web-Based Perioperative Preparation Program: Directed Content Analysis

    Abstract:

    Background: Web-based technology is useful as an alternative means of providing preparation programs to children in pediatric care. To take full advantage of Web-based technology, there is a need to understand how children use and learn from such programs. Objective: The objective of this study was to analyze children’s use of and experiences with a Web-based perioperative preparation program in relation to an educational framework of children’s learning. Methods: This study is the final part of a three-phase study in which all families with children aged 3 to 16 years (N=32) admitted for outpatient surgery over 1 week were asked to participate. Children were interviewed before (phase 1) and after (phase 2) anesthesia and surgery and 1 month after hospitalization (phase 3). The data in this study (phase 3) relate to six children (5 to 13 years) who participated in the follow-up interviews in their homes a month after hospitalization. The study used a directed qualitative interpretative approach. The interviews were conducted in a semistructured manner as the children—without guidance or influence from the interviewer—visited and navigated the actual website. The data were analyzed based on a combination of the transcribed interviews and field notes, and were subjected to a previous theoretical investigation based on children’s learning on a website in pediatric care. Results: Six children, five boys (5-12 years) and one girl (13 years), participated in the follow-up study in their homes a month after hospitalization. The children were selected from the 22 initially interviewed (in phases 1 and 2) to represent a variation of ages and perioperative experiences. The children’s use of and experiences with the website could be explained by the predetermined educational themes (in charge of my learning, discover and play, recognize and identify, and getting feedback), but additional aspects associated with children’s need for identification, recognition, and feedback were also revealed. The children used the website to get feedback on their own experiences and to interact with and learn from other children. Conclusions: This analysis of children’s use of and experiences with a Web-based preparation program emphasizes the importance of including a theoretical educational framework of children’s learning in the development and design of websites in pediatric care. Creating opportunities for Web-based communication with others facing similar experiences and possibilities for receiving feedback from adults are important factors for future consideration.

  • 360 degree video tour demonstration in patient consultation room. The video can be viewed by the patient and the child life therapist simultaneously. Source: Image created by the Authors; Copyright: The Authors; URL: http://periop.jmir.org/2019/1/e11259/; License: Creative Commons Attribution (CC-BY).

    An Interactive Virtual Reality Tour for Adolescents Receiving Proton Radiation Therapy: Proof-of-Concept Study

    Abstract:

    Background: Child life therapists provide patient education for children undergoing radiation therapy to assist in coping with and understanding their treatment. Objective: This proof-of-concept study aimed to determine the feasibility of incorporating a 360-degree video tour via a virtual reality system for children scheduled to receive radiation therapy. The secondary objective was to qualitatively describe each subject’s virtual reality experience. Methods: Children aged ≥13 years scheduled to receive proton radiation therapy were included in the study. Subjects watched the 360-degree video of the radiation therapy facility in an immersive virtual reality environment with a child life therapist experienced in coaching children receiving radiation therapy and completed a survey after the tour. Results: Eight subjects consented to participate in the study, and six subjects completed the 360-degree video tour and survey. All the enrolled patients completed the tour successfully. Two subjects did not complete the survey. Two subjects requested to pause the tour to ask questions about the facility. Five subjects said the tour was helpful preparation before undergoing proton radiation therapy. Subjects stated that the tour was helpful because “it showed [them] what’s to come” and was helpful to see “what it’s like to lay in the machine.” One subject said, “it made me feel less nervous.” Six subjects stated that they would like to see this type of tour available for other areas of the hospital, such as diagnostic imaging rooms. None of the subjects experienced nausea or vomiting. Conclusions: The 360-degree video tour allowed patients to explore the treatment facility in a comfortable environment. Participants felt that the tour was beneficial and would appreciate seeing other parts of the hospital in this manner.

  • Patient lying in supine position. Source: Unsplash; Copyright: Marlon Lara; URL: https://unsplash.com/photos/9bHGQcKlqMg; License: Licensed by JMIR.

    The Trendelenburg Position and Cognitive Decline: A Case-Control Interventional Study Involving Healthy Volunteers

    Abstract:

    Background: Postoperative cognitive decline (POCD) is defined as a new cognitive impairment arising after a surgical intervention. Aspects of cognitive function can be assessed using various validated cognitive function tests including the N-back task, the Stroop task, and the lexical decision-making task (LDT). There is some concern that prolonged Trendelenburg positioning during laparoscopic colorectal surgery may cause POCD. Objective: The objective of this study was to assess the effect of time spent in the Trendelenburg position on cognitive function. Methods: Volunteers were placed in the Trendelenburg position for 3 hours and, then, supine for 30 minutes. Validated cognitive function tests including 1-, 2-, and 3-back tasks, Stroop test, and LDT were performed at baseline and every 30 minutes after Trendelenburg positioning. Cognitive decline was defined per the International Study of Postoperative Cognitive Dysfunction trial: a decrease in accuracy from the volunteers’ baseline or an increase in response time from the volunteers’ baseline by >2 control group SDs. Results: We recruited 15 healthy volunteers (8 males, 7 females) with an average age of 69 years (range 57-81) and average body mass index of 27.7 kg/m2 (range 20.9-33). Accuracy remained within 2 SDs at all time points. An increase in response time did occur, and of 15 participants, 3 (20%) showed cognitive decline in the Trendelenburg position after 30 minutes, 4 (27%) after 1 hour, 5 (33%) after 90 minutes, 4 (27%) after 120 and 150 minutes, and 6 (40%) after 180 minutes. On moving to a supine position, 33% (5/15) participants showed cognitive decline. Conclusions: The results of this study indicate that Trendelenburg positioning leads to cognitive decline. This may have implications for patients undergoing prolonged Trendelenburg positioning during laparoscopic colorectal surgery.

  • Patient interacting with home monitor to send blood pressure measurements to clinicians. Source: The Authors; Copyright: The Authors; URL: http://periop.jmir.org/2018/2/e10169/; License: Licensed by JMIR.

    Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls

    Abstract:

    Background: A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements. Objective: The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis. Methods: After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2. Results: A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can $5826.32 (SD 1418.89) in the POHM group and Can $9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5%) and 2 readmissions (1.9%) in the control group. No mortalities occurred in either group. Conclusions: The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively. Clinical Trial: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P)

  • Pectus carinatum. Source: Wikimedia Commons; Copyright: Tolson411; URL: https://commons.wikimedia.org/wiki/File:Ben_Fraser_pectus_carinatum.jpg; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Implementation of an Enhanced Recovery Pathway for Minimally Invasive Pectus Surgery: A Population-Based Cohort Study Evaluating Short- and Long-Term...

    Abstract:

    Background: Pectus excavatum and pectus carinatum are the most common chest wall deformities. Although minimally invasive correction (minimally invasive repair of pectus, MIRP) has become common practice, it remains associated with severe postoperative pain. Preoperative psychosocial factors such as anxiety and low self-esteem can increase postsurgical pain. Early detection of psychological symptoms, effective biopsychosocial perioperative management of patients, and prevention of pain chronification using an enhanced recovery pathway (ERP) may improve outcomes. However, the incidence of the latter is poorly described in adolescents undergoing MIRP. Objective: The objective of our study was to evaluate the implementation of an ERP containing early recovery goals and to assess persistent postsurgical pain 3 months postoperatively in pediatric patients undergoing MIRP. The ERP consists of a Web-based platform containing psychological screening questionnaires and extensive telemonitoring for follow-up of patients at home. Methods: A population-based cohort study was conducted with prospectively collected data from patients undergoing pectus surgery between June 2017 and December 2017. An ERP was initiated preoperatively; it included patient education, electronic health-based psychological screening, multimodal pre-emptive analgesia, nausea prophylaxis as well as early Foley catheter removal and respiratory exercises. After hospital discharge, patients were followed up to 10 weeks using a Web-based diary evaluating pain and sleep quality, while their rehabilitation progress was monitored via Bluetooth-connected telemonitoring devices. Results: We enrolled 29 adolescents using the developed ERP. Pre-emptive multimodal analgesia pain rating scores were low at hospital admission. Optimal epidural placement, defined by T8-9 or T9-10, occurred in 90% (26/29) of the participants; thus, no motor block or Horner syndrome occurred. Mean bladder catheterization duration was 3.41 (SD 1.50) days in ERP patients. Numeric rating scale (NRS) scores for pain and the incidence of nausea were low, contributing to a fluent rehabilitation. Mean NRS scores were 2.58 (SD 1.77) on postoperative day (POD) 1, 2.48 (SD 1.66) on POD 2, and 3.14 (SD 1.98) on POD 3 in ERP-treated patients. Telemonitoring at home was feasible in adolescents after hospital discharge despite adherence difficulties. Although the pain scores at the final interview were low (0.81 [SD 1.33]), 33% (9/27) long-term follow-up ERP patients still experienced frequent disturbing thoracic pain, requiring analgesic administration, school absenteeism, and multiple doctor (re)visits. Conclusions: Allocating patients to the appropriate level of care preoperatively and immediately postoperatively may improve long-term outcome variables. Internet-based technologies and feasible, objective monitoring tools can help clinicians screen surgical patients for risk factors and initiate early treatment when indicated. Future research should focus on improving risk stratification and include a psychological assessment and evaluation of the effect of perioperative care pathways in children undergoing major surgery. Trial Registration: ClinicalTrials.gov NCT03100669; https://clinicaltrials.gov/ct2/show/NCT03100669 (Archived by WebCite at http://www.webcitation.org/72qLB1ADX)

  • Mother and child using Anaesthesia-Web. Source: Anaesthesia-Web; Copyright: Anaesthesia-Web; URL: http://periop.jmir.org/2018/2/e10203; License: Licensed by JMIR.

    Web-Based Learning for Children in Pediatric Care: Qualitative Study Assessing Educational Challenges

    Abstract:

    Background: Hospitalization is a significant and stressful experience for children, which may have both short-term and long-term negative consequences. Anaesthesia-Web is a Web-based preparation program that has been well received and is being used worldwide to reduce stressful experiences, increase understanding, and exchange information in pediatric care. A deeper theoretical and educational understanding encompassing children’s learning processes on Anaesthesia-Web may optimize and support the development and design of similar websites for children in pediatric care. Objective: The objective of this study was to elucidate key educational principles in the development and design of websites for children in pediatric care. Methods: A directed qualitative content analysis was applied to analyze the content and design of Anaesthesia-Web from a theoretical and educational perspective. preunderstanding, motivation, learning processes, and learning outcome were used to analyze the learning possibilities of Anaesthesia-Web for children prior to contact with pediatric care. Results: We found 4 themes characterizing children’s learning opportunities on Anaesthesia-Web in the analysis: “In charge of my learning”; “Discover and play”; “Recognize and identify“; and “Getting feedback”. The analysis showed that Anaesthesia-Web offers children control and enables the use of the website based on interest and ability. This is important in terms of motivation and each child’s individual preunderstanding. Through discovery and play, children can receive, process, and apply the information on Anaesthesia-Web cognitively, emotionally, and by active participation. Play stimulates motivation and is very important in a child’s learning process. When facing pediatric care, children need to develop trust and feel safe so that they can focus on learning. On Anaesthesia-Web, children can recognize situations and feelings and can find someone with whom to identify. Several features on the website promote feedback, which is necessary to judge learning achievements, confirm understanding, and embody the need for repetition. Conclusions: Web-based preparation programs are important learning resources in pediatric care. Content and design needs to change from simply providing information to embracing the importance of a child’s need to process information to learn and fully understand. By developing Web-based preparation programs that include educational principles, Web-based technology can be used to its fullest advantage as a learning resource for children. The 4 educational themes described in this study should help future similar website developments within pediatric care.

  • Anonymous patient interacting with remote monitor. Source: Image created by the Authors; Copyright: The Authors; URL: http://periop.jmir.org/2018/2/e10168/; License: Creative Commons Attribution (CC-BY).

    Postoperative Home Monitoring After Joint Replacement: Feasibility Study

    Abstract:

    Background: We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. Objective: The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%. Methods: Patients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. Results: We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to “I would recommend the Remote Monitoring System program to future patients” was 4.5 (interquartile range 4-5), with 1 being “strongly disagree” and 5 “strongly agree.” At 30 days postop, there was no mortality or readmission. Conclusions: This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals. Trial Registration: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk)

  • Source: Pxhere; Copyright: Pxhere; URL: https://pxhere.com/en/photo/1100015; License: Public Domain (CC0).

    Evaluating the Variation of Intraocular Pressure With Positional Change During Colorectal Laparoscopic Surgery: Observational Study

    Abstract:

    Background: The incidence of perioperative visual loss following colorectal surgery in the US is quoted as 1.24 per 10,000. Raised intraocular pressure (IOP) during extreme Trendelenburg position leading to reduced optic nerve perfusion is thought to be a cause. Objective: To assess the effect of the degree of Trendelenburg tilt and time spent in Trendelenburg on IOP during laparoscopic colorectal surgery. Methods: Fifty patients undergoing laparoscopic colorectal surgery were recruited. A Tonopen XL applanation tonometer was used to take IOP measurements hourly during surgery, and each time the operating table was tilted. A correlation coefficient for the degree of Trendelenburg tilt and IOP was calculated for each patient. Group 1 included patients undergoing a right-sided colonic procedure, and Group 2 included all left-sided colonic operations. Results: The mean age of Group 1 participants (n=25) was 69 years (SD 14), and Group 2 (n=25) was 63 years (SD 16; P>.05). The average length of surgery for Group 1 was 142 minutes (SD 48), and Group 2 was 268 minutes (SD 99; P≤.05). The mean maximum degree of Trendelenburg tilt in Group 1 was 10 (SD 7) and Group 2 was 19 (SD 6; P≤.05). The mean IOP increase was 9 mm Hg (SD 5) for Group 1 and 15 mm Hg (SD 5) in Group 2 (P≤.05). An overall correlation coefficient for the degree of Trendelenburg tilt and IOP change (n=48) was .78. Conclusions: There is a strong correlation between IOP elevation during laparoscopic colorectal surgery and the degree of Trendelenburg tilt. This may be significant for patients undergoing prolonged surgery and especially those with glaucoma.

  • Source: Rotterdam Eye Hospital; Copyright: Rotterdam Eye Hospital; URL: http://periop.jmir.org/2018/1/e3/; License: Creative Commons Attribution (CC-BY).

    A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study

    Abstract:

    Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process. Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact. Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding. Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad. Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.

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  • Benefits and pitfalls of electronic patient reported outcome measures: a systematic review

    Date Submitted: Jul 25, 2019

    Open Peer Review Period: Jul 29, 2019 - Sep 23, 2019

    Background: Patient Reported Outcome Measures (PROMs) are important in clinical practice and research. The growth of (e)-health technologies provide unprecedented opportunities to systematically col...

    Background: Patient Reported Outcome Measures (PROMs) are important in clinical practice and research. The growth of (e)-health technologies provide unprecedented opportunities to systematically collect information via PROMs. Objective: The aim of this study was to give an objective and comprehensive overview of the benefits, barriers and pitfalls of digital collection of qualitative data with electronic Patient Reported Outcome Measures (ePROMs). Methods: A systematic review was performed in Pubmed and Web of Science. PRISMA guidelines were followed during all stages. The search strategy yielded a total of 2333 records from which 32 met the predefined in- and exclusion criteria. Relevant ePROM related information from each study was extracted. Results: Results were clustered in benefits and pitfalls. Reported benefits of ePROMs were a higher patient preference and acceptability, lower costs, equal or faster completion time, better data quality and response rates and facilitated symptom management and patient-clinician communication. Within the included studies tablets seem the most used ePROM modality (44%) and as a platform web-based systems seem (81%) most applied. Aspects to consider as possible pitfalls are privacy protection, a possible initial large financial investment and exclusion of certain populations or ‘digital divide’. Conclusions: In conclusion the ePROMs offers many advantages over paper administration. Overall, they are preferred more, data quality improves, completion time is equal or faster, costs are lower and clinical decision making and symptom management is facilitated. Disadvantages regarding ePROMs have been mapped and suggestions are stated to counter-act these pitfalls. We provide a path forward for researchers and clinicians interested in implementing ePROMs.

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