Intraoperative Telemedicine Program Shows Room for Improvement: ACTFAST-3 Study
By Danélia Botes
September 28, 2023
Introduction to the ACTFAST-3 Study The Anesthesiology Control Tower (ACT), a real-time telemedicine decision support system, was tested in the ACTFAST-3 Randomized Clinical Trial. The study aimed to evaluate the feasibility of the ACT and its impact on two quality of care measures: postoperative hypothermia and hyperglycemia.
The ACTFAST-3 study, a single-center pilot superiority RCT, took place in the USA from April 2017 to June 2019. The study involved all patients aged 18 years and above who had undergone surgery. However, the study did not include patients if the ACT staff did not staff more than 50% of their case duration or if they did not suffer from diabetes (for glycemic outcomes).
Results and Implications The pilot study, involving 26,254 patients, found that the telemedicine decision support intervention did not significantly alter the two quality of care outcomes. While there was a slight increase in intraoperative glucose measurement in the intervention group, there was no difference in the frequency of treatment for hyperglycemia. This lack of difference could explain the unchanged postoperative hyperglycemia rates.
The study also highlighted potential reasons for these results. For instance, the high adherence to each measure at baseline made significant improvements challenging. Also, the trial noted the impact of the Hawthorne effect, where changes in behaviour occur due to the awareness of being observed. The study concluded that further optimization of clinical decision support and workflows might help the intraoperative telemedicine program achieve improvement in targeted clinical measures.
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