A PROCESS MONITORING EVALUATION OF A NURSE-LED REMOTE AUTOMATED MONITORING AND VIRTUAL CARE INTERVENTION

Abstract

Clinical trials involving digital health technologies are complex and challenging deployments. The SMArTVIEW trial (n=800), underway, combines remote automated patient monitoring (RAM) in hospital and virtual hospital-to-home nursing support, up to 30-days post-discharge, for patients who have undergone cardiac and major vascular surgery. Cardiac and vascular surgery patients are at risk for postoperative complications, as well as hospital readmission; SMArTVIEW aims to reduce hospital readmissions and emergency department visits. The purpose of this work was to conduct a process monitoring evaluation of the first 100 patients enrolled in order to examine the implementation, mechanisms, context, and specialized nursing role of the SMArTVIEW intervention. Six data sources were used to examine patient recruitment, daily nursing intervention workflows, RAM technology compliance, technical troubleshooting, patient education, and virtual nursing care. A content analysis was used to identify nursing advice, recommendations, and corrective actions for patients requiring intervention recovering at home. Fifty patients were allocated to the SMArTVIEW intervention; of these, 34 engaged in all intervention components, both in-hospital and at home. In-hospital RAM technology generated 194 notifications, drawing nurses to the beside for patient reassessment. Forty-two daily nurse reports and 926 virtual nursing care records were audited to determine technology implementation issues and nursing actions to support patient recovery at home. Process monitoring uncovered strengths and limitations in the initial days of intervention deployment. Strengths included the functionality of RAM technology, facilitating nurse compliance with required workflows, as well as a high degree of patient engagement in the program. SMArTVIEW nurses addressed multiple health concerns for patients, resulting in 1,865 nursing actions over the 30-day intervention course. Patient withdrawals and lack of standardized communication practices were areas requiring improvement. Results were used to refine and standardize intervention workflows in order to scale the intervention for deployment at a second site (United Kingdom).