Patients that undergo surgery resulting in a stoma (ileostomy or colostomy) suffer a significant burden of morbidity in terms of increased length of stay, increased hospital readmissions for dehydration and acute kidney injury, skin complications and impaired quality of life (1). There is a wide variation in both the patient education and perioperative support offered. We aimed to design a patient-centered care pathway, incorporating remote patient monitoring and telehealth technologies and focused on the outcomes that matter most to patients.
I. Sapci1, R. Fearn2, S. Mehta2, I. Dorofeeva2, K. Grayson2, E. Gorgun1
1Cleveland Clinic, Cleveland OH, 211 Health and Technologies Inc., Tustin, California
Intestinal stomas have previously been associated with complications that can have a large impact on quality of life. Leakage occurs in 68% and peristomal skin complications in 41% (1) (2).
Furthermore increased length of stay, increased hospital readmissions for dehydration and acute kidney injury (up to 15%) are frequently reported (3).
The reported rates of complication vary considerably between studies and depend on definition and methodology. We aimed to evaluate the impact of the formation of an ostomy on rates of readmission and acute renal failure following major colorectal surgery.
R. Belk1, X. Anaya1, K. Solis1, R. Fearn1
111 Health and Technologies Inc., Tustin, California
Ostomates are prone to complications, including skin irritation, acute kidney injury (AKI) and hospital readmissions. Impaired quality of life (QOL) is commonly reported, particularly in the early postoperative period. In a systematic review of quality of life in colorectal cancer stoma patients, all studies demonstrated that living with a stoma influenced the overall QOL negatively. Painful or irritated peristomal skin, odor and a sense of loss were the most commonly reported ostomy-related difficulties (2).
Empowering stoma patients to self-manage has been shown to reduce complications including readmission and dehydration. For example, when ward staff, community clinicians and patients were educated to be aware of the importance of stoma self-management and hydration, readmission rates were reduced from 14.9% to 2.4% (3). A patient-centered self-care checklist for patients with ileostomy also significantly reduced readmission rates (4). Mastering stoma management has been found to be key in rebuilding social confidence after stoma surgery (1), stressing the specific importance of patient education in self-management. This is particularly important given the general drive towards enhanced recovery and earlier discharge of patients in the current healthcare economy.
Whilst existing hospital and nurse led programs can offer a great deal of formal and informal patient support, peer support from other patients can be vital to aid in the adjustment. Peer support programs offer a method to manage the complex factors involved in chronic disease management. A systemic review addressing the role of peer support in managing non-communicable diseases found that 82.6% of patients reported significant benefits of peer support (5). Benefits have been noted across multiple diseases and patient groups including inflammatory bowel disease (6, 7) and cancer (8, 9). A recent study demonstrated that a self-help ostomy survivorship intervention is affordable and effective (10). Social media is broadly used by patients across health conditions and disease types. Benefits such as increased community support, greater social connectedness, health management, health promotion and knowledge acquisition have been reported (11, 12).
Here we report on the impact of a novel remote peer support program utilizing both social media and direct support from a one to one peer support health coaching program that aims to improve quality of life for ostomates.
P. Daneshyar1, R. Belk1, K. Solis1, R. Fearn1
111 Health and Technologies Inc., Tustin, California
11 Health’s patient coaching program pairs new stoma patients with a patient coach. A patient coach is a trained health coach who has experienced the same clinical condition. The coach acts as a patients first point of contact during their recovery from surgery.
The patient coaching program is designed to deliver both emotional and educational support to new patients. This includes structured topic-specific coaching sessions between the patient, their coach and a registered ostomy nurse.
Many patients report feeling overwhelmed post-surgery and often fail to cope with the increased risk they face from dehydration. It is currently the most common cause for readmission among ileostomy patients, present in approximately 40% (1, 2).
Here we demonstrate how a topic-specific education session can lead to increased patient confidence levels and user engagement with remote care tools.
Patients have unique insights to invent tools that improve outcomes and make life easier, but Jacqui Thornton finds that it can be a long slog getting an invention used widely
This March, in Australia, a landmark passed quietly for Tal Golesworthy, a chartered engineer from Cheltenham in the UK.
He was in Melbourne with the cardiothoracic surgeon Conal Austin to speak at the Australasian Thoracic Aortic Symposium about personalised external aortic root support (PEARS), an operation in which an implant supports the patient’s own aorta and aortic valve, and is designed to prevent enlargement and rupture.
While in Australia, Austin, based at Guy’s and St Thomas’ NHS Foundation Trust, carried out six of these life changing operations as a visiting surgeon.
Golesworthy knew exactly what those patients were going through, because he experienced the first operation of this kind, nearly 15 years ago, for aortic dilatation relating to his Marfan syndrome.
What was the difference between him and these latest patients? Golesworthy had used his engineering skills to invent the implant used in PEARS surgery after he had been told the only clinical option for him was total aortic root replacement, which offers patients the drawback of a lifetime of anticoagulant therapy. He refused and set about developing an alternative, which was successfully implanted in him in 2004.
Guy Yeoman,1 Patricia Furlong,2 Michael Seres,3 Helena Binder,4 Helena Chung,5 Vincenzo Garzya,1 Rachel RM Jones6
Background Patient engagement is an essential aspect in the research/development of biopharmaceutical products and disease management. Improving the lives of patients requires a deep understanding of their medical conditions, experiences, needs and priorities. However, a consistent definition of patient centricity is lacking. A series of initiatives was conducted to define patient centricity and its important principles impacting the biopharmaceutical industry.Intestinal stomas are frequently constructed by colorectal surgeons either electively or emergently. Perioperative high stoma output is associated with increased length of stay, readmission and renal failure.
R. Fearn1, D. Ziring2, K. Solis1, I. Dorofeeva1, C. Landon3
111 Health and Technologies Inc., Tustin, California; 2Cedars Sinai Hospital, Los Angeles, California; 3Ventura County Medical Centre, Ventura, California
Intestinal stomas are frequently constructed by colorectal surgeons either electively or emergently. Perioperative high stoma output is associated with increased length of stay, readmission and renal failure.
Leakage results in reduced quality of life and skin complications. Patients and healthcare professionals struggle to measure stoma output accurately....
Dr Robert I. Fearn M.D.
Medical Director, 11 Health and Technologies
In October 2018 surgical teams from ten major hospital systems in New York, Cleveland, Massachusetts and California began to recruit patients into a multicentre service evaluation pilot analysing the impact of a novel remote monitoring and care pathway for new ostomy patients.
The intervention incorporated remote monitoring, peer support, telehealth nursing and home healthcare components. Remote monitoring was provided through a 'smart' stoma bag and base-plate system (11 Health and Technologies Inc.), an FDA approved product which utilizes capacitive and thermal data to map stoma output and saturation of the base-plate in real time....