Presentation Authors: Frederic Birkhäuser, Felix Moltzahn, Jean-Luc Zehnder, Sebastian Flückiger, Daniel Hasler, Pascal Zehnder*, Lucerne, Switzerland
Introduction: Readmission rates after cystectomy remain considerable despite established enhanced recovery after surgery concepts. We developed a cell phone-based application (APP) to intensify and standardize patient-physician communication. The aim was to evaluate the APPâ€™s potential in terms of early complication detection, physician intervention and herewith prevention of readmissions following cystectomy.
Methods: Pilot series with 18 cystectomy patients (9 neobladders, 9 conduits). During hospital stay, the APP was downloaded on the patientâ€™s cell phone and instructions given. The first month, patients received twice a week a push notification indicating that data input was required. This was reduced to once a week in month 2-3. As variables, body weight, body temperature, fluid intake/output volumes, nausea/vomiting (yes/no), defecation (yes/no) and a pain score were chosen for the recording. Patients were also offered space for individual remarks.Recorded data were checked by the surgeon using the same APP. If deemed necessary, patients were contacted (surgeon) to get more clinical information allowing to decide, whether a control visitation was required.Finally, patients were asked to estimate the usefulness of the APP.
Results: 5 patients could not be enrolled (no cell phone). All 18 study patients completed the 90 days period. Overall, 95% of push notifications were answered. No patient skipped more than one data input. No one required readmission. Two times, interceptions were necessary. One neobladder patient with fever 3 weeks after discharge was given antibiotic therapy for suspicion of beginning pyelonephritis. Another patient with weight loss and nausea and therefore suspicion of metabolic acidosis after 2 months was advised to increase his sodium-bicarbonate and fluid intake. All participants felt reassured having a chance to communicate with their surgeon and judged the APP as an extremely valuable tool.
Conclusions: APP-based recording of clinical parameters within the fragile 90-day post cystectomy period provides the surgeon with meaningful information. In this pilot series, two potential readmissions could be omitted due to relatively simple interceptions by the involved surgeon. Compliance was excellent. All patients estimated this straight forward communication tool as reassuring and extremely valuable. The modifiable APP can potentially be used for any kind of therapy control within all medical specialties.