SeamlessMD Podcast – Episode 39 – Rush Study Review: Value of an Interactive Phone Application in an Existing Enhanced Recovery Program

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Video:

In this episode of the SeamlessMD Podcast, Dr. Joshua Liu, CEO at SeamlessMD & Marketing colleague, Alan Sardana, review a manuscript from the Journal of Colorectal Disease, “Value of an Interactive Phone Application in an Existing Enhanced Recovery Program“*. See the full show notes below for details.

*Schlund, D., Poirier, J., Bhama, A.R. et al. Value of an interactive phone application in an established enhanced recovery program. Int J Colorectal Dis35, 1045–1048 (2020). https://doi.org/10.1007/s00384-020-03563-5

Guest(s): Dr. Joshua Liu (@joshuapliu), Co-founder & CEO at SeamlessMD

Episode 39 – Show notes:

[1:40] Introducing the manuscript, “Value of an Interactive Phone Application in an Established Enhanced Recovery Program” and its authors: Devan Schlund1, Jennifer Poirier2, Anuradha R Bhama3, Dana Hayden3, Theodore Saclarides3, Bruce Orkin4, Joanne Favuzza5.

[2:28] How SeamlessMD partnered with Rush in late 2016 for their colorectal ERAS program and why the main goal of this study was to determine the impact of SeamlessMD on ERAS compliance & clinical outcomes (length of stay, readmissions, surgical site infections, total cost of care) since the Length of Stay improvements had plateaued for the ERAS program;

[9:18] How participants included all patients undergoing colorectal ERAS surgery between February 2017 and July 2018, regardless of whether they opted into the phone application;

[9:40] How patients would receive a patient education booklet provided by trained nurses during a pre-operative clinical visit and how they would consent for SeamlessMD following this clinic visit;

[11:10] How 289 patients were enrolled in the study (147 patients with SeamlessMD and 142 without);

[12:11] How ERAS compliance was measured for oral intake, solid food intake, % of patients completing bowel prep, and % of patients adhering to ERAS medication;

[12:20] Discussing ERAS Compliance Results:

Oral & solid food intake:  No significant change between groups, however, patients with SeamlessMD were trending in the right direction;

Bowel prep completion: 74.8% of patients did bowel prep with SeamlessMD vs. 66.2% without (p=0.059);

ERAS medication adherence: 82.1% with SeamlessMD vs. 76.8% without (p=0.005);

[14:14] Why patients might be more compliant with ERAS protocols using digital patient engagement since the patient journey is complex and technology helps to distill information into bite-sized pieces and explains context for each protocol (e.g. why bowel prep is important for surgery);

[20:27] Discussing Clinical Outcomes Results:

Readmission rates: No significant variance between groups;

(There was no remote patient monitoring enabled, which is a strong factor in influencing change in readmission rates as seen by other SeamlessMD partners);

Surgical site infections (SSIs): 70% reduction in SSIs with SeamlessMD (p=0.019); (3.4% of patients had SSI with SeamlessMD vs. 11.3% had SSI without SeamlessMD);

Length of stay: 2.0 days reduction in mean length of stay with SeamlessMD (p=0.006); (4.4 days avg. with SeamlessMD vs. 6.4 days avg. without);

Total cost of care: $2,386 reduction in total cost of care with SeamlessMD (p=0.024);

($11,560 avg. cost with SeamlessMD vs. $13,946 avg. cost without);

[24:00] Why clinical outcomes may have improved with SeamlessMD because of increased patient compliance to ERAS elements such as the chlorhexidine wash before surgery which would have impacted SSI rates;

[29:09] Discussing the study limitations:

1. Small sample size (only conducted at one medical institution);

2. Lack of randomization (due to opt-in nature of study);

3. Did not measure compliance to all ERAS components;

4. (Not a study limitation but a technological limitation) The group took a hands-off approach and did not utilize SeamlessMD’s remote patient monitoring capabilities which may have reduced readmissions;


1 Department of General Surgery, Rush University Medical Center,
Chicago, IL, USA

2 Rush Alzheimer’s Disease Center, Rush University Medical Center,
Chicago, IL, USA

3 Department of General Surgery, Division of Colon and Rectal
Surgery, Rush University Medical Center, Chicago, IL, USA

4 Advent Health Center for Colon and Rectal Surgery, University of
Central Florida, Orlando, FL, USA

5 Department of Surgery, Division of Colon and Rectal Surgery,
Boston Medical Center, FGH Building 820 Harrison Avenue, Room
5008, Boston, MA 02118, USA


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