Post Discharge After Surgery Virtual Care With Remote Automated Monitoring Technology-3 Trial

Length of stay from randomization until discharge from the index hospitalization (measured in days and hours)

Acute-hospital care is a composite outcome of hospital re-admission and emergency department visit, which includes urgent-care centre visit.

Patient admission to an acute-care hospital.

Patient visit to an emergency department, which includes urgent-care centre visit.

Medication errors include mistakes in medication prescribing, transcribing, dispensing, administering, or monitoring due to preventable events or actions taken by a patient, caregiver, or healthcare worker. Medication errors include: drug omission (i.e., patient did not take a drug they were supposed to take), drug commission (i.e., patient taking a drug they were not supposed to take), duration error, dosing error, frequency error, route error, and timing error. We will record all drug errors identified.

Any medication error that is corrected.

Surgical site infection is an infection that occurs within 30 days after randomization and involves the skin, subcutaneous tissue of the incision (superficial incisional), or the deep soft tissue (e.g., fascia, muscle) of the incision (deep incisional).

Days in hospital

Pain intensity and related interference with usual daily activities, will be measured via the Brief Pain Inventory-Short Form (BPI-SF).4 The BPI-SF includes four 11-point numeric rating scales (NRS) of pain intensity, which measure "average", "least", and "worst" pain intensity in the past 24 hours (hrs.), respectively, as well as pain intensity "now" (0= no pain, 10= pain as bad as you can imagine). The BPI-SF interference subscale will also be used, which measures the degree to which pain interferes with general activity, mood, walking, work, relations with others, sleep, and enjoyment of life (NRS for each item; 0=does not interfere, 10=completely interferes). A total interference score is determined by calculating the sum of these 7 items. The BPI-SF has strong psychometric properties with well-established reliability and validity across divergent surgical groups. Moderate to severe pain is defined by a score of ≥4/10 on a standard numeric rating scale (NRS) for pain.

Among patients with atherosclerotic disease, we will also assess optimal pharmacological management based upon whether patients are taking 0, 1, 2, or 3 of the following classes of efficacious medications at 30 days (i.e., an antiplatelet or anticoagulant drug; an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker; and a statin). Among active smokers before surgery we will assess if patients are receiving pharmacological smoking cessation interventions at 30 days after randomization.

Infection is defined as a pathologic process caused by the invasion of normally sterile tissue, fluid, or body cavity by pathogenic or potentially pathogenic organisms.

Re-operation refers to any surgical procedure undertaken for any reason (e.g., wound dehiscence, infection).

The diagnosis of myocardial infarction requires criteria meeting 4th universal definition of myocardial infarction.

The definition of acute heart failure requires at least one of the following clinical signs (i.e., elevated jugular venous pressure, respiratory rales or crackles, crepitations, or presence of S3) with at least one of the following:

• radiographic findings of vascular redistribution, interstitial pulmonary edema, or frank alveolar pulmonary edema, OR
• heart failure treatment with a diuretic and documented clinical improvement.

Any arrhythmia that results in patient presenting to an emergency department, which includes an urgent care centre visit or being admitted to hospital.

All cause mortality

HRQoL will be measured with the EQ-5D-5L instrument (https://euroqol.org/eq-5d-instruments/sample-demo) due to its increased sensitivity and validation in several countries including Canada.4 The EQ-5D-5L is also recommended in Canada5 to calculate the Quality Adjusted Life Years (QALYs) when conducting cost-effectiveness analyses.

Data on hospital re-admission, length of stay, and healthcare utilization will be obtained from the Ontario Hospital Association Integrated Decision Support (IDS) database. IDS is a comprehensive platform with an integrated view of patient activity, allowing for access to health systems data for any patients enrolled. Data on costs of health service utilization will be obtained from the Ontario Case Costing Database.