Robotic telerounds match bedside rounds in patient satisfaction

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There is no difference in patient-reported satisfaction when comparing standard rounds with telerounds, suggesting there are trends toward a difference in favor of telerounding for the items regarding physician availability and delivery of medical information, according to a study published in the December 2007 issue of The Archives of Surgery.

The randomized, controlled trial, conducted at the University of California Davis Medical Center, Johns Hopkins Hospital and Sentara Health of Norfolk, Va., sought to assess the safety and satisfaction of robotic telerounding in patients undergoing elective laparoscopic or endoscopic urologic surgical procedures. Investigators hypothesized that patient safety and satisfaction are adversely affected when robotic videoconferencing (telerounding) is used in the postoperative setting.

A total of 270 adults, older than 18 years, undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours, were randomized to receive either traditional bedside rounds or robotic telerounds. The primary outcome measure was differences in rates of attending surgeon–identified complications between standard rounds and telerounds. The secondary outcome measures included differences in hospital length of stay and patient-reported satisfaction with hospitalization. The primary end point of the study was patient morbidity. The expected rate of complications (major and minor) after a laparoscopic urologic procedure was 16 percent.

According to the results, patients were equally distributed based on the baseline demographic and operative measures. Morbidity rates were similar between the study arms (standard rounds vs. telerounds: 16 percent vs. 13 percent). Length of stay was similar in both arms (standard rounds vs. telerounds: 2.8 vs. 2.8 days). In addition, patient satisfaction was equivalently high in both arms of the study.

“Robotic telerounds matched the performance of standard bedside rounds after urologic surgical procedures,” said Lars M. Ellison, MD, co-investigator. “Virtual visits did not result in missed or increased postoperative complications and the hospital length of stay and ratings of hospital satisfaction were on par with those for traditional rounding.”

For the cohort patients studied, Ellison said they found “no difference in outcomes comparing those managed with standard bedside rounds with those managed with telerounds. There were no instances of failed identification of morbidities by telerounding that were subsequently identified by resident staff (false-negatives), nor were there inappropriately identified morbidities when in fact none existed (false-positives).”

Investigators tempered the results with a few caveats. First, the patient population selected had anticipated recovery times of 24 to 72 hours and investigators suggest the robust performance of this system may not necessarily be replicated for patients with evolving or slowly resolving medical conditions. For these patients, physical examination findings may play a more central role in evaluation.

Second, telerounding is not an absolute replacement for bedside rounds. Physicians must be prepared to abandon the system when patients require direct physical assessment. It is difficult to compile a comprehensive list of absolute indications that require a bedside visit.

Researchers stressed, however, that the observed performance of the telerounding system in this study was “a function of the high index of suspicion demonstrated by the participating physicians. Decrements in the level of suspicion could lead to measurable decrements in telerounding safety. These patients were also seen by resident house staff, so the results may not directly translate to the general community setting.”