Updated: Oct 26, 2021
Infiniwell and Predisan successfully completed a joint project evaluating the feasibility of remotely monitoring post-operative patients in Catacamas, Honduras. This important evaluation took place at Predisan’s Good Samaritan Clinic, from August 22 through August 27, 2021. During this timeframe, a U.S. surgical brigade from Jackson Healthcare led by Chad Eustis, MD, performed 45 surgical cases. 16 of the 45 patients were safely and successfully post-operatively monitored using Infiniwell’s Sentio patient monitoring software platform and Clarity’s Recobro Vigile vital signs monitor. One patient that had been recovering without incident and was transferred to remote monitoring became suddenly unstable. Because the patient was being monitored in near real-time, the dramatic drop in blood pressure and SpO2 was immediately identified, and appropriate measures were initiated. The patient was stabilized, and after extended monitoring was released without further incident. The result of this project clearly demonstrated that Infiniwell’s Sentio near real-time remote monitoring of appropriate post-operative patients is a viable solution. This process can safely allow an increase in the number of operations performed by surgical brigades, thus reducing the surgical waitlist (and resultant morbidities and mortalities). The Sentio monitoring solution by Infiniwell also demonstrated high patient, resident staff, and brigade satisfaction. The implications of this project are significant, as there are many similar scenarios (such as outpatient surgery centers) that could benefit from remote post-operative monitoring.
“The remote patient monitoring system (RPMS) worked very well. It allowed us to expand the functional size of our recovery room, which relieved a bottleneck. It also allowed us to prolong monitoring of higher risk patients. It was easy for the PACU staff to learn to use, with a familiar and intuitive layout.”
T. Chadwick Eustis, MD, FACS
Lead Brigade Surgeon
Infiniwell is a Saas based patient monitoring AI solutions company with a focus on underserved global populations. Infiniwell is unique in that we can provide intelligent health solutions regardless of the device type, patient needs, data platform, or geographic location. This means Infiniwell can provide near real-time monitoring solutions for a wide range of patient health needs, from ICU grade vital signs monitoring (in care facilities or at home), to health/wellness, and disease prevention. Using AI (artificial intelligence) and user-friendly apps, Infiniwell offers clinicians the ability to monitor patients both safely and remotely.
Predisan is a faith-based, highly respected not-for-profit organization that provides medical and surgical care to those that cannot afford other options. Predisan’s main clinic is in Catacamas, a city of about 100,000, also has 52 clinics in the surrounding remote mountains of Olancho, Honduras. While private Honduran surgeons do operate at Predisan, they average about 20-30 cases per month, whereas U.S. surgical brigades will usually perform 50-60 cases per week. These brigades operate primarily on patients that are on a surgical waitlist.
Honduras is a poverty laden country that has nationalized and privatized healthcare, but severe limitations in medical accessibility exists. There are government-run clinics, but no local government hospital. The nearest government hospital is an expensive, difficult two-hour drive from Catacamas. As a result, typically over 150 patients end up on a surgical waitlist for 6-18 months, while some wait even longer. Because of these and other factors, many patients in Honduras rely on surgical/medical brigades from the U.S. to receive their care.
During the Covid-19 pandemic, no brigades were allowed in Honduras for nearly 18 months. Thus, the surgical waitlist continued to grow.
Even prior to the pandemic, several issues existed (and still do) that limit the number of cases the surgical brigades can perform. There are only two operating rooms at the Good Samaritan clinic with a small PACU (Post-Anesthesia Care Unit) housing four recovery beds. This creates a bottleneck, which ultimately can be a limiting factor in the number of surgeries performed by each brigade. Additionally, some patients require an overnight stay and must be re-evaluated the following morning prior to resuming the days’ surgeries. This requires time, review of the overnight data, and is another bottleneck.
The post-op remote monitoring project was based upon the following guiding principles:
1. Patients must meet previously agreed upon criteria
2. No peri-operative complications
3. Age 18-65, signed consent, and follow standard brigade protocols
4. Satisfaction surveys would be obtained from surgical brigade members, monitored patients, and the Predisan staff involved in the project
1Clinical care using remote near real-time monitoring will be equal or superior to traditional post-operative care.
Patients will report positive satisfaction with the remote monitoring experience on the satisfaction survey.
The remote monitoring project analysis should confirm that the process would allow more operations to be performed by the surgical brigade. This will reduce the surgical wait list, and potentially reduce morbidity and/or mortality of those waiting for surgery.
The surgical brigade’s confidence and overall mission experience providing patient care in Honduras will be enhanced. This will be measured using satisfaction questionnaires (surgeon, anesthetist, nurse).
All surveys utilized the same scoring system using 1-5, where 1=Strongly Disagree, 2=Disagree, 3=Neutral, 4=Agree, 5=Strongly Agree
Patient survey results (averaged) from those monitored were as follows:
1. I understood the remote monitoring process 4.4/5
2. I think I received good care after surgery 4.6/5
3. I understood the benefits of remote monitoring 4.3/5
4. I was satisfied with my care after surgery 4.8/5
5. I would use remote monitoring for future surgery 4.7/5
Predisan staff survey results:
1. I understood the potential benefits of the project 4.9/5
2. Remotely monitored patients received at least similar care 5.0/5
3. Remotely monitored patients received higher quality monitoring 4.6/5
4. The remote monitoring process was safe and effective 4.8/5
5. I would recommend continuing this process for future brigades 5.0/5
6. I believe the project was overall successful 5.0/5
Surgical brigade survey results:
1. I understood the potential benefits of the project 4.6/5
2. Remotely monitored patients received at least similar care 4.4/5
3. Remotely monitored patients received higher quality monitoring 4.0/5
4. The remote monitoring process was safe and effective 4.7/5
5. I would recommend continuing this process for future brigades 4.7/5
6. I believe the project was overall successful 4.6/5
Infiniwell’s Sentio Monitoring solution was used to demonstrate that it is both safe and feasible to remotely monitor appropriate post-operative patients. By remotely monitoring post-op patients using near real-time technology, organizations like Predisan can increase the number of patients served in a timely manner, while increasing satisfaction and productivity of surgical brigades. While this project was completed in a rural third world country, the same safety and improved productivity principles should apply to urban centers, including ambulatory surgery centers.
David Bragg, MD
CMO and SVP Clinical Integration