Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system.

OBJECTIVE: The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery. SUBJECTS AND METHODS: Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. RESULTS: A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. CONCLUSIONS: We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.

Effect of the combination of music and nature sounds on pain and anxiety in cardiac surgical patients: a randomized study.

BACKGROUND: Postoperative pain and anxiety are common in cardiac surgery patients. Studies have suggested that music can decrease anxiety in hospitalized patients. Primary Study Objective This study focused on the efficacy and feasibility of special music, which included nature sounds, for pain and anxiety. METHODS/DESIGN: In this randomized controlled trial, postoperative cardiovascular surgery patients were randomly assigned to a music group to receive 20 minutes of standard postoperative care and music twice daily on postoperative days 2 through 4 or to a control group to receive 20 minutes of standard care with a quiet resting period twice daily on postoperative days 2 through 4. SETTING: Cardiovascular surgical unit of Saint Marys Hospital, Rochester, Minnesota. PARTICIPANTS: One hundred patients completed the study (music group, n = 49; control group, n = 51). Intervention The music was delivered through CD players in the patients' rooms. PRIMARY OUTCOME MEASURES: Pain, anxiety, satisfaction, and relaxation were evaluated from visual analog scales. RESULTS: Data showed a significant decrease in mean (SD) pain scores after the second session of day 2 for the music group (change, ?1.4 [1.4]) compared with the control group (change, ?0.4 [1.4]) (P = .001). Mean relaxation scores improved more at the first session of day 2 for the music group (change, 1.9 [2.7]) compared with the control group (change, 0.3 [2.9]) (P = .03). The music group also showed lower anxiety and increased satisfaction overall, but these differences were not statistically significant. No major barriers to using the therapy were identified. CONCLUSION: Recorded music and nature sounds can be integrated into the postoperative care of cardiovascular surgery patients. The recordings may provide an additional means for addressing common symptoms of pain and anxiety while providing a means of relaxation for these patients.

Surgical Process Improvement: Impact of a Standardized Care Model With Electronic Decision Support to Improve Compliance With SCIP Inf-9.

The absence of standardization in surgical care process, exemplified in a "solution shop" model, can lead to unwarranted variation, increased cost, and reduced quality. A comprehensive effort was undertaken to improve quality of care around indwelling bladder catheter use following surgery by creating a "focused factory" model within the cardiac surgical practice. Baseline compliance with Surgical Care Improvement Inf-9, removal of urinary catheter by the end of surgical postoperative day 2, was determined. Comparison of baseline data to postintervention results showed clinically important reductions in the duration of indwelling bladder catheters as well as marked reduction in practice variation. Following the intervention, Surgical Care Improvement Inf-9 guidelines were met in 97% of patients. Although clinical quality improvement was notable, the process to accomplish this-identification of patients suitable for standardized pathways, protocol application, and electronic systems to support the standardized practice model-has potentially greater relevance than the specific clinical results.

Functional recovery in the elderly after major surgery: assessment of mobility recovery using wireless technology.

PURPOSE: Hospitalization and surgery in older patients often leads to a loss of strength, mobility, and functional capacity. We tested the hypothesis that wireless accelerometry could be used to measure mobility during hospital recovery after cardiac surgery. DESCRIPTION: We used an off-the-shelf fitness monitor to measure daily mobility in patients after surgery. Data were transmitted wirelessly, aggregated, and configured onto a provider-viewable dashboard. EVALUATION: Wireless monitoring of mobility after major surgery was easy and practical. There was a significant relationship between the number of steps taken in the early recovery period, length of stay, and dismissal disposition. CONCLUSIONS: Wireless monitoring of mobility after major surgery creates an opportunity for early identification and intervention in individual patients and could serve as a tool to evaluate and improve the process of care and to affect postdischarge outcomes.

Patient engagement and reported outcomes in surgical recovery: effectiveness of an e-health platform.

BACKGROUND: Electronic health information platforms have the potential to support standardized care delivery models, engage patients, and deliver patient self-assessment tools. STUDY DESIGN: We tested whether an e-health platform could support the delivery and acquisition of patient-reported outcomes (PROs) during hospitalization after cardiac surgery. Secondarily, we tested if patient reported data were predictive of resource use (length of stay) or outcomes (discharge disposition). Subjects were 149 cardiac surgical patients, over age 50 years, undergoing routine surgery, with an expected length of stay of 5 to 7 days. While hospitalized, patients were provided with iPads (Apple), which delivered a personalized care plan. That plan included daily patient "To Do" lists with self-assessment modules that included recovery-related patient reported outcomes. Those included an early screen for discharge planning (ESDP) as well as daily pain and mobility self-assessments using the visual analog pain scale and the I-MOVE mobility scale. We measured completion rates for the self assessments, determined length of stay (short, intermediate, or long) and discharge disposition (home independently or other), and evaluated whether patient self-assessments were predictive of these outcomes. RESULTS: Patients completed 98% of the 1,418 self-assessments that were delivered. The ESDP and mobility self-assessments were predictive of length of hospital stay (p = 0.004 and p = 0.012, respectively) and of discharge disposition (p < 0.0001 and p < 0.007, respectively). Lower ESDP scores and higher I-MOVE scores were predictive of shorter lengths of stay and a higher likelihood of discharge to home independently. CONCLUSIONS: Our trial demonstrated that an e-health platform, combined with mobile computing, can effectively deliver customized care plans with which patients can interact. Furthermore, patient self-reported data are predictive of length of stay and discharge disposition.