Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators

Citation

McLean KA, Sgrò A, Brown LR, Buijs LF, Mozolowski K, Daines L, Cresswell K, Potter MA, Bouamrane M & Harrison EM (2024) Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators. BMC Medical Informatics and Decision Making, 24 (1), p. 14. https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02670-5; https://doi.org/10.1186/s12911-024-02670-5

Abstract
Introduction: Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service. Methods: A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care. Results: There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfill an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients’ expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications. Conclusion: The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care.

Keywords
Perioperative Medicine, Digital remote postoperative monitoring, tele-health, tele-monitoring, qualitative study of digital health, implementation science

Journal
BMC Medical Informatics and Decision Making: Volume 24, Issue 1