The abbreviation MEDAL-C stands for Monitoring Early Discharge After Laparoscopic Colorectal surgery. In the study, all patients up to the age of 80 who undergo a planned intestinal operation can go home the next day if they wish. There they are followed via home monitoring. “Because this is a study, we curently have one bed available in the hospital,”
Verdaasdonk emphasizes. “If there is some- thing unexpected, there is always room. In this study, patients are not officially discharged but go on leave for three days.”
According to the intestinal surgeon, one of the biggest problems in healthcare is caused by the shortage of personnel. That gave him the idea to see what else could be achieved with technology. Not just in the operating room, but throughout the entire patient journey. According to him, there should be options to discharge patients from the hospital earlier after surgery. Where you used to have to stay in the hospital for five to ten days to recover after an appendectomy, people are now sent home after one day.
Verdaasdonk and his team started preparing for the research in 2019. About 80 percent of patients do not experience any complications after surgery. But you do not know in advance who the patients are who will develop a complication. Complications often arise on the second or third day after surgery. These days, patients are all still in the hospital.
Advantage of rehabilitation at home
“People are getting older these days and that also means patients with an extensive medical history. These are vulnerable patients who recover well if there are no complications, but deteriorate quickly if a complication does oc- cur. A person over 70 who has never had anything before has more physical reserve than a patient who, for example, has previously survived a heart attack and has kidney failure. This trend also influences staff pressure and rising healthcare costs. So if patients can recuperate at home through home monitoring, this has many advantages.”
To monitor properly, you need reliable equipment. Equipment that properly measures the values and also adequately transmits those values to the healthcare providers in the hospital. The technology used by the patient at home must communicate flawlessly with the technology in the hospital. But: how do you test something like that?
“Simply by testing devices from different suppliers yourself,” says Verdaasdonk. “All five members of the project group took the sensors home, stuck them on them and linked them to our telephone. Then we just started working, sleeping, walking. The next day we went to the hospital to check whether all the data had been received correctly. We even checked whether we also had allergic reactions from the plasters we had to put on.”
Stable supply of data
Normally, nurses keep a close eye on patients in the hospital after an operation. Three times a day they measure values such as temperature, blood pressure, oxygen levels in the blood and heart rate. These are the values that the equipment used in the study had to be able to measure anyway, says Verdaasdonk about the choice of equipment.
“But with home monitoring I also wanted to be able to measure continuously. That's why I came across Masimo technology. It offered all those options and you had insight into the values and limit regulations at which time an alarm had to be sent. Other brands of sensors did not have these options and I did not want to be offered an algorithm that I had no access to. In the case of the Masimo sensors, we could also set the alarms ourselves. We receive a signal in the hospital when a value exceeds the expected amount. Then we could call the patients."
If patients rehabilitate at home through home monitoring, this has many advantages
According to the intestinal surgeon, it is important for home monitoring that the data supply does not falter and is stable. The data that is passed on is clearly visible to the patient. The healthcare providers in the hospital see all the data coming in from the patients connected to the sensors on a dashboard.
Innovation platform
When choosing the equipment, Verdaasdonk and his team received help from the hospital's innovation platform (I-Team) and engineer Robert van der Westen from TU Eindhoven. Together they drew up a list of the 'must haves' and the 'nice to haves' of values they wanted to measure. And so they started looking for sensors for the research.
“The starting point was that you want to know in a timely manner whether a patient will also develop complications at home. You want to know as early as possible whether something is wrong with a vulnerable patient so that we can return the patient to the hospital in a timely manner. There was no research available yet showing which values are good predictors of whether someone will develop complications or not through home monitoring. If someone develops complications at home and those values are passed on, there may be a delaying factor. And then someone has to come to the hospital. We have researched that carefully.”
Before admission to the hospital, the researchers told patients about the possibility of home monitoring. People could indicate them- selves whether they wanted to use this. “It is their choice whether they want to participate. To participate, they must have a smartphone and live within a radius of thirty kilometers from the hospital. And of course have your own transport to get to the hospital if necessary. The process is largely carried out by a team of nurses. They are excellent ambassadors for this home monitoring and explain everything well to the patients,” Verdaasdonk explains.
Research results
It was agreed in the study that 60 patients must be connected to Masimo's network in order to draw conclusions. At the beginning of July, 32 people were connected to the system. Of the 32 people who have been connected so far, 20 patients have actually gone home after the operation. On second thought, the other 12 preferred not to go home.
Verdaasdonk: “Of the 20 people who did go home, we saw 5 back early. But those 5 people can be easily explained. In one case it was nausea and he was given an anti-nausea medication. Once there was an abnormal value in the measurements, but that was a huge fever spike. That person had no further complaints, but we still called him to check just to be sure. And in three patients we called, there was a technological problem. The measurements did not come through properly. We had agreed in advance during the study that if that were to happen, we would recall the patients. Both the patients and us could clearly see that it was a technological issue, so no one was concerned.”
It is expected that 60 patients will have been connected by September or October and the results can be shared.
Curriculum Vitae – Emiel Verdaasdonk
Emiel Verdaasdonk is a colorectal & oncological surgeon at the Jeroen Bosch Hospital. In addition to being a surgeon, Verdaasdonk has a technical background. After studying medicine, he did PhD research at TU Delft.
“Technology is what makes my work extra interesting. I operate a lot with the help of robots. I am interested in anything that breathes technology.”
