Feasibility of Remote Digital Monitoring Using Wireless Bluetooth Monitors, the Smart Angel™ App and an Original Web Platform for Patients Following Outpatient Surgery

A Prospective Observational Pilot Study

Thierry Chevallier; Gautier Buzancais; Bob-Valéry Occean; Pierre Rataboul; Christophe Boisson; Natacha Simon; Ariane Lannelongue; Noémie Chaniaud; Yann Gricourt; Jean-Yves Lefrant; Philippe Cuvillon


BMC Anesthesiol. 2020;20(259) 

In This Article


Population of the Study, Surgery and Ambulatory Setting

From May 2018 to September 2018, 30 patients were included and 29 analysed (1 patient was excluded as "ambulatory" as he was not discharged from hospital due to delayed surgery). Patients (15 male, 14 female) were 47 ± 13 years with a body mass index of 25 ± 3 kg.m−2 and an ASA physical status 1/2 (n = 14/15). Surgery was either orthopaedic (n = 24, shoulder = 3, foot = 12, knee = 9) or abdominal (n = 5). Mean duration of surgery was 42 ± 21 min.

Primary Outcome

For 29 patients, 3248 (29x16x7) data items were to be collected on paper or by remote monitoring technology. The remote monitoring technology recorded 2038 data (62%) (Table 1).

The conventional paper form recorded 2656 (82%) data. The difference between remote monitoring and paper form was statistically significant (p = 0.001) (Table 1). Figure 2a and b show the percentage of data recorded by patients per day at each time period on paper and via the web-solution, respectively.

Figure 2.

a: Patient's written recordings. b: Patient's remote monitoring

Secondary Outcome

Concerning remote technology, three patients reported malfunctioning of the MAP monitor for all assessments from Day 0 to Day 5. The absent variables were later attributed to an internal software malfunction. On the eve of surgery, 12 (41%) patients reported difficulty to use the technology at home (forgotten password or login to starting using the tablet = 4, absence of 4G connection = 1, difficulty to transmit data from monitor to tablet = 7). On Days 1 and 2, 11 (39%) patients reported technical difficulties (4G connection = 1, difficulty to transmit data from monitor to tablet = 10). From Day 3 to Day 5, 9 (35%) patients reported similar difficulties.

With regard to usability, three patients did not perform the SUS survey. For the other 26 patients, the mean SUS score was 85 (68–93).

With regard to postoperative adverse effects during the first 5 days, the app recorded nausea in 7 patients and vomiting in one. These adverse events were consistent with the data noted by the patients on the paper forms. No patients were readmitted for adverse events during the study period.

On Day 30, 3 patients (10%) were readmitted for minor adverse outcomes (surgical complications), but none were due to the device.