Vital Signs

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T E L E H E A LT H Home Monitoring Goes to New Level for Post-Surgery Heart Patients U CLA heart-surgery patients now are receiving an unusual type of follow-up care after they return home from the hospital. Rather than a phone call to find out how they’re doing, patients are being equipped with video teleconferencing technology and paired with a nurse practitioner who places video calls at defined intervals, depending on their level of risk, to do a visual check of their recovery. Th rough UCLA’s new cardiac telehealth program, patients also are being equipped upon discharge with a preprogrammed mobile device that includes a Bluetooth weight scale, pulse oximeter and heart-rate monitor. The device helps patients know what medications they should be taking and when, as well as providing verbal and visual reminders to regularly log their physiological information so that the healthcare team can ensure they are progressing appropriately. The value of the program — and a similar one for patients with heart failure — is twofold: It is convenient for patients by allowing them to have “virtual visits” rather than needing to travel to UCLA for follow-up appointments; and through the more intense monitoring at home after the patient’s discharge from the hospital, the healthcare team can reduce hospital readmissions by addressing the early signs of a problem. UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) Nationally, 15-to-20 percent of heart-surgery and heart-failure patients are readmitted to the hospital within 30 days of their initial discharge. Such readmissions are associated with higher mortality rates. “Th is is a major problem for all hospitals,” says Peyman Benharash, MD, UCLA cardiothoracic surgeon, who is spearheading the telehealth program for heart-surgery patients. “Our goal is to more closely work with patients after they leave the hospital so that if any problem arises, we can make sure it doesn’t reach the point where they need to go to the emergency room or be readmitted to the hospital.” Through the cardiac telehealth program, Dr. Benharash explains, the healthcare team is able to detect and immediately address issues such as shortness of breath, dehydration, abnormal heart rhythm, fluid retention and early signs of pneumonia, as well as any negative reactions to medications. In an initial study looking at 50 high-risk patients who were part of the telehealth program, the readmission rate was only 6 percent. While heart-surgery and heart-failure patients are particularly targeted because of their high readmission rates, UCLA Health is exploring the use of similar telehealth approaches for patients with other conditions that have high rates of hospital utilization, explains UCLA internist Michael Ong, MD, PhD. Other groups Dr. Ong and colleagues have identified include patients with chronic obstructive pulmonary disease and those with end-stage liver disease. “Rather than having patients come in for frequent post-discharge visits, we can allow them to stay at home and get blood pressure, heart rate and other important information from them remotely,” Dr. Ong says. Dr. Ong notes that the issue goes beyond reducing preventable hospital readmissions. “Technology has advanced to the point that these devices are much less obtrusive, and patients are increasingly interested in using them if it’s going to improve their health,” he says. “We are still learning how best to incorporate it, but it’s clear that this approach is part of the next evolution of healthcare. It allows us to use real-time information to optimize care for our patients, and we are working on creating the knowledge for how best to use these devices.” To view a video about cardiac home monitoring, go to: heartmonitoring