Good morning, Shannon Cropwell here on behalf of my colleagues at Atrium Health in Charlotte and Sanger Heart and Vascular, I'd like to thank this society. I have no disclosures. So I'm going to take you back a little bit before we dive into the technologies on our paired procedural journey to build in the platform for our quality improvement program. So as you've heard our colleagues talk today, the research and a lot of the evidence-based and guidelines are out there, especially associated with cardiac surgery, but you have to have the infrastructure built to plug and play and operationalize some of these guidelines. So for us, the journey started all the way back in 2004 and we created our quality infrastructure and developed like standard practice routines, goal sheets, multidisciplinary rounding so we could plug and play these guidelines and things that we're learning about. Then we kind of moved on in 2011 to doing more of the virtual type work and it was so important as we spread and our practices were growing across different institutions on how do we have the expertise with an intensivist as well as APPs to kind of spread and scale some of our guidelines. So we created tele-rounding, our virtual critical care center, and then launched our perfect care quality initiative in 2018. And with that, creating this infrastructure and quality support system, you know, we saw major improvement, 40% reduction in our overall mortality, 80% in tamponade, 50% in sepsis, and 30% in our renal failure, and it's just having this infrastructure again created to plug and play these guidelines and then having the dashboards to control your metrics. So diving into now more of the peri-procedural and the technology-based with that, we launched perfect care in 2018 and it's really a platform that engages and educates our patients. Prior to surgery and follows them for 90 days post-operatively. So what we do is we give them a digital health kit that includes an activity fitness tracker, a scale, and a blood pressure monitor that will monitor their heart rate, their steps and activity, as well as their blood pressure and their fluid status balance. So a lot of this, we have all the fancy tools that you talked about in the lab when they're in our brick-and-mortar hospital, but once we send patients out, back after discharge, how do we still deliver that same quality level of care to produce those outcomes outside the brick-and-mortar? So patients download an application on their phone, and with that, we're able to push out messaging, patient-reported outcomes, audio-video visits to check in with them on a weekly basis, again, messaging to avoid the phone mail chase that you do once patients are discharged, and the overall game was to improve our 30-day readmissions as well as our mortality and our length of stay. So this was more important than ever as we were faced with the pandemic, and that just kind of, there's not a whole lot we can say that was worked in our favor during a pandemic globally, but for us to be able to launch this and then have it ready so when the pandemic hit, keeping people out of the hospital as well as decreasing that length of stay and that bad backflow. So the first year, we, again, took it back down to the basics with what is our standard practices and protocols from a peri-procedural? How are we going to make sure patients are risk-adjusted and medically optimized before we ever take them to the operating room to give that successful surgery? The second phase of it was developing that post-operative pathway of discharge, again, how do we set this patient up for success once we get them out of the hospital to keep them out of the hospital? We worked with several different technology platforms to test and aggregate data to see what that needed and what metrics we needed to follow, as well as work with our IT partners to, you know, is it EMR integration? So with all that being said, as of November of last year, we've enrolled over 1,000 patients into our peri-procedural remote patient monitoring platform. A couple of things that I listed up here just for you to see when we go back to what those standard practice routines look like were handoff communication tools in between phases of care, developing an AFib pathway protocol for preventing AFib not only in the hospital but afterwards when they're sent from discharge. So just coming up with some of those standard practice to really form this whole peri-procedural, so prior to surgery, throughout your hospital, and then 90 days post-operatively to kind of give the overall perspective. So diving into the remote patient monitoring platform, patients can be enrolled in two forms. One is an elective patient that comes in from our outpatient clinics, and they are downloaded the application on their phone, as well as given in their digital help kit, and then we get baseline data for them. So sometimes a week or two weeks up to surgery, especially our valve patients, we see what their dry weights were, where their blood pressure, what's their baseline heart rate. The second is for those patients that are coming in more of an urgent emergent, and we do not have the opportunity to enroll them prior because they came in through the cath lab or the ED and we've never sent them home. We work with our case management and our discharge nurses on the inpatient side to enroll these patients prior to them going home. Once they are enrolled and set up, we discharge them from the hospital, and within 24 to 48 hours, they have their first encounter with their nurse navigator. That same nurse navigator, if they came in from an outpatient setting that did all their pre-op education, so they built that record with the clinical team. They review their biometric data, again, their steps, their heart rate, their blood pressure. Really, really important when we're looking at some of our valve patients, what their dry weights, you know, managing their diuretics. They do this at 48 hours post-discharge, and then weekly, they have a scheduled appointment where they are given surveys. How are you feeling today compared to yesterday? Are you short of breath at rest? Are you short of breath at activity? How is your pain on zero to 10? Are you taking narcotics? Are you using your acetaminophen and gabapentin? Taking it back to that multimodal pain, all the ERAS guidelines. And we're following them on a weekly basis, proactively for 30 days. We don't wait on the patient. Call me if you need me. That was our old mentality before we launched this program. And then at 30 days, we bring them back for their first inpatient appointment post-operatively, and they see an APP. At that time, we release them back to cardiology, but we continue to monitor them for 90 days. Are you going to cardiac rehab? How is your mobility advancing? This is a couple of views that I think kind of really relates and brings it to life, is this in the top left is a weight. So you can see, I know the patient's weight started at 203 pounds. Currently they're at 184, so they've had about a 19 weight loss. So we typically give about 10 pounds of fluid, as we're talking about our AKI post-operatively between the OR and ICU. I want to gradually pull that fluid off. So do we send them home with a diuretic? Do we not send them home with a diuretic? Are they getting too dry? Are they getting fluid overloaded? The same way that the heart rate, you can see, we've had several patients, it's not uncommon, probably one of our biggest bears, is fighting post-operative AFib once they get home from the hospital. So because they're wearing this activity tracker, we can see their baseline heart rates. We can see if their heart rate's going up or down. We've prevented several hospital readmissions, and even having to bring them into the office, because I can tell that their heart rate has went from resting in the 80s, 70s now, to they're up to 110. So trying to be able to treat that arrhythmia is on a post-operative. Down here is an exciting one to the left as well, on the bottom. And it shows a patient's steps and mobility. We know getting patients up and moving is the best thing to enhance their recovery. So the bright pink here is what a patient was walking prior to surgery. The light color down here in the middle is their in-hospital stay. So they're still wearing their tracker as they're ambulating on post-op day one and two. And then the darker teal here is over 90 days, how their steps and activity progressed over the journey. We also have the opportunity in these dashboards that we've created to look at a more population view. So this is the average patient walking at leaving the hospital versus 30 days, 60 days, and 90 days. Patient reported outcomes. I'm going to let my colleague Cheryl expand more on this, but we have the ability to send those surveys and these questionnaires out through the application. And this just is one that we use, the PROMIS survey that focuses on mental and physical health. We're still working on our one-year mark, right, after they've graduated the program at 90 days. How do we have the same evaluation at one year? But you can see from pre-op, four weeks, eight weeks, and 12 weeks, the increase in their overall mental and physical health. And Cheryl's going to speak more on patient reported outcomes. So with all this being said, we've exceeded over 1,000 patients into our peri-procedural remote patient monitoring platform. Over 2,000 virtual visits were encountered and over 600 interventions. So when I say interventions, what does that mean? As the nurse navigator is having these audio-video visits and they're tweaking diuretics and blood pressure management and heart rates, those are the interventions. Are we ordering labs for home help to come out there and draw labs on them? Are we getting chest x-rays and preventing a readmission from a pleurifusion because we're able to manage that more on an outpatient basis? We feel we've avoided over 200 clinic visits and over 134 emergency visits. The overall satisfaction from a patient standpoint from just the program in itself, 98% rated it good, very good, or excellent. And from the digital health kit, the technology, the application, and the devices that were given these patients, they rated over 92%. Overall the results, we've chipped off one day of our average length of stay and our 30-day readmissions has been cut in half to about 4.9%. So down here on the bottom is one of our STS dashboards that we created that's our metrics that we follow. Just in our isolated CAB population, there was 458 patients that were enrolled. Of those, we had zero post-operative mortality and our length of stay, again, as you can see, was down to six versus seven is the medium. And then our readmission rate, the STS national average is about nine in this patient population and ours was 4.9. So again, almost cut in half the national benchmark for readmissions within 30 days. So in summary and conclusion, we feel like that we've reached our quadruple aim, which was to deliver better outcomes, improve our clinician outcomes experience, improve our patient experience, and we did all this at a lower cost. We're spreading this now within our institution for outside of cardiac surgery now for doing more surgeries as well as like a hypertension work. And we're also partnering with our collaboratives at Virginia and Maryland to hopefully launch the same RPM program there. Thank you guys again.

peri-procedural remote patient monitoring platform

Atrium Health

Charlotte

digital health kits

patient satisfaction