IMPLEMENTATION OF A PATIENT-CENTERED MOBILE APPLICATION TO REDUCE COMPLICATION BURDEN AFTER CYSTECTOMY: A PILOT STUDY

Abstract

Introduction

Radical cystectomy (RC) remains the mainstay of treatment for muscle invasive bladder cancer. RC carries high rates of morbidity and mortality, with readmission rates exceeding 25% within the first 90 days. Three quarters of these readmissions occur in the first 30 days following discharge, many of which are result from modifiable causes, such as dehydration and infection. These complications translate to worse patient outcomes, increased financial burden on patients and increased health care resource utilization. One method to identify and manage postoperative complications following discharge after RC is through enhanced post-operative patient monitoring and improved education. Mobile health presents an innovative and contemporary approach to tracking symptoms immediately following discharge. Our objective was to create and assess feasibility of an electronic medical record (EMR)-integrated platform to track post-operative symptoms for patients who underwent radical cystectomy.

Methods

A convenience sample of 15 patients who underwent robotic radical cystectomy by a single surgeon between August 2022-March 2024 at an academic medical center consented to participate. A cystectomy specific Care Companion (CC), an Epic© application that allows for push notifications and two-way communication between patients and providers, was created and integrated into the EMR. Following hospital discharge, patients received push notifications assessing post-operative symptoms, pain, nutritional intake, hydration, and activity. Abnormal responses prompted educational materials or generated clinical messages to the medical team, depending on severity. The frequency of push notifications decreased over time, but occurred at least daily until day 35. Concerning symptoms from the CC were automatically uploaded into the EMR, alerting all providers on the care team and promoting early follow-up.

Results

Patients were discharged from the hospital between 3-8 days postoperatively, with a median discharge day of POD4. Three patients experienced complications postoperatively, two of which required readmission. Readmission was due to bacteremia (n=1) and concurrent acute myeloid leukemia relapse (n=1).

11 of the 15 patients (73%) answered notifications at least once after discharge. Engagement with notifications was highest during the first 2 weeks after discharge, with 49% of patients responding to at least one notification daily, compared to 36% in weeks 3-5 (Figure 1). Two patients reported new symptoms through the triage questions, including new incision drainage and fever, both of which triggered provider alerts and follow-up. Of the two patients that were readmitted, one of the two patients used the care companion application regularly, responding 60% of days prior to readmission. Responses had high variability both between patients and within a single patient (Figure 2).

Conclusions

An EMR-integrated mobile application offered a streamlined approach to tracking convalescence after radical cystectomy, has the potential to identify complications and reduce readmissions. We identify that integration of this interactive technology into the EMR is feasible. This integration facilitated communication and minimized barriers of patients’ access to the urology care team. Patient engagement was highest during the first two weeks of discharge, and decreased thereafter, with relatively consistent use through day 35. Patient response included a variety of information pertaining to convalescence that may serve as early indicators of a developing complication. Concerning symptoms prompted follow-up with providers, allowing providers to evaluate patients sooner. Responses had high variability both between patients and within a single patient demonstrating value in tracking patient reported outcomes over time.