Intraoperative Telemedicine Program Fails To Improve Perioperative Quality Measures: JAMA

Dr Christopher R. King and colleagues at Washington University School of Medicine, USA have found in a recent single-center pilot randomized clinical trial that support from an intraoperative telemedicine center augmented by real-time clinical decision support did not affect intraoperative quality of care measures.

The clinical trial called ACTFAST-3 (Anesthesiology Control Tower–Feedback Alerts to Supplement Treatments) was  aimed to implement real-time intraoperative telemedicine decision support and assess its impact on various aspects of surgical care. The study, conducted over several years, involved a substantial number of adult surgical patients and aimed to improve the quality of intraoperative care.

The study has been published in JAMA Network Open. 

The objective was to implement real-time intraoperative telemedicine decision support and evaluate its impact on postoperative hypothermia, hyperglycemia, and other quality of care measures.

Study Period: The trial was conducted from April 3, 2017, to June 30, 2019, at a large academic medical center in the US.

Participants: A total of 26,254 adult surgical patients were included in the study. They were randomised into two groups: usual intraoperative care (control group; n = 12,980) or usual care supplemented by telemedicine decision support (intervention group; n = 13,274).

Data Analysis: Data were initially analyzed from April 22 to May 19, 2021, with updates in November 2022 and February 2023.

Usual Care: Patients in the control group received standard intraoperative care with medical direction from the anaesthesia care team.

Telemedicine Decision Support: Patients in the intervention group received intraoperative anaesthesia care monitored and enhanced by decision support from the Anesthesiology Control Tower (ACT), a real-time telemedicine intervention. The ACT involved remote monitoring of operating rooms by anaesthesia clinicians using customised analysis software. The ACT team reviewed alerts and electronic health record data to provide recommendations to operating room clinicians.

Main Outcomes and Measures

The primary outcomes assessed in the study were the prevention of postoperative hypothermia (defined as the proportion of patients with a final recorded intraoperative core temperature >36 °C) and hyperglycemia (defined as the proportion of diabetic patients with a blood glucose level ≤180 mg/dL upon arrival in the postanesthesia recovery area). Secondary outcomes included intraoperative hypotension, temperature monitoring, timely antibiotic redosing, intraoperative glucose evaluation and management, neuromuscular blockade documentation, ventilator management, and volatile anaesthetic overuse.

• Among the 26,254 participants, 13,393 (51.0%) were female, and 20,169 (76.8%) were White, with a median age of 60 (47-69) years.
• The intervention did not show a treatment effect on the prevention of hyperglycemia (85.8% in the intervention group vs. 85.8% in the control group) or hypothermia (66.4% in the intervention group vs. 66.7% in the control group).
• Intraoperative glucose measurement was more common among patients with diabetes in the intervention group, but other secondary outcomes did not show significant differences between the groups.

This randomised clinical trial found that anaesthesia care quality measures did not significantly differ between the groups, indicating that the telemedicine intervention did not impact the targeted care practices. The study suggests that further refinement of clinical decision support and workflows may be necessary to achieve improvements in the targeted clinical measures during intraoperative care.

Reference:

King, C. R., Gregory, S., Fritz, B. A., Budelier, T. P., Ben Abdallah, A., Kronzer, A., Helsten, D. L., Torres, B., McKinnon, S., Goswami, S., Mehta, D., Higo, O., Kerby, P., Henrichs, B., Wildes, T. S., Politi, M. C., Abraham, J., Avidan, M. S., Kannampallil, T., … ACTFAST Study Group. An intraoperative telemedicine program to improve perioperative quality measures: The ACTFAST-3 randomized clinical trial. JAMA Network Open,2023;6(9), e2332517. https://doi.org/10.1001/jamanetworkopen.2023.32517