A pilot RCT of an mHealth self-help intervention on readmission rate reduction after adult cardiac surgery: preliminary findings

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The Royal Melbourne Hospital Background Readmission is multifaceted, potentially avoidable and costly. Patients’ ability to enact self-care behaviors after cardiac surgery are under-investigated. Purpose To evaluate the feasibility of a RCT investigating an mHealth intervention for self-help, and readmission rate reduction. Methods Elective adult (>18 years) elective cardiac surgery (via median sternotomy) patients were eligible for inclusion. Patients had to be discharged home, able to understand spoken English, and own and use a smartphone, tablet or computer. The intervention comprised a narrative online library (Healthily GoShare platform) with videos describing patient and carer experiences focused on preoperative preparation, acute postoperative care (sent within 1 week of discharge) and ongoing recovery Sent 30 days after surgery). Patients were randomised preoperatively 1:1 to the intervention, accessible via a text or email link, or the control group receiving usual care that comprised postoperative education and a brochure. Follow-up phone interviews took place 30, 60 and 90 days after surgery. Results From August 2021 to December 2022, 341 (65%) patients were scheduled for elective surgery, 229 (67.2%) were transferred elsewhere secondary to COVID-19 bed closures, 22 (6.5%) were undergoing reoperation, 13 (3.8%) did not adequately understand spoken English and 7 (2.1%) did not own a smartphone or tablet. Of the 70 (20.5%) eligible patients, 61 (87.1%) agreed to participate and 2 (2.8%) did not proceed. Follow-up (FUP) is complete for 43 (72.9%) patients. Accessed preoperative 14 (63.6%), postoperative 16 (72.7%) and recovery bundles 12 (54.5%) were reported as helpful or very helpful by 95% (n = 21) of participants. A single patient from the intervention group was lost to FUP at 30 days and 5 control group patients at 60 days. 30-day readmission was more frequent in the control (3/21, 14.3%) than intervention group (0/22; p = 0.06). Conclusion(s): Findings to date indicate COVID-19 bed closures have impacted on elective surgical scheduling thus recruitment. The intervention was feasible and acceptable. To be 95% confident the readmission rate is within 10%, assuming a 15% readmission rate, a minimum of 50 patients are required. Follow-up is ongoing.