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Video:

In this episode of the ɫ��ֱ�� Podcast, Dr. Joshua Liu, CEO at ɫ��ֱ�� & Marketing colleague, Alan Sardana, review a manuscript from the Journal of Colorectal Disease, ""*. See the full show notes below for details.

*Schlund, D., Poirier, J., Bhama, A.R. et al. Value of an interactive phone application in an established enhanced recovery program. Int J Colorectal Dis35, 1045–1048 (2020). https://doi.org/10.1007/s00384-020-03563-5

Guest(s): Dr. Joshua Liu (), Co-founder & CEO at ɫ��ֱ��

Episode 39 – Show notes:

[1:40] Introducing the manuscript, “” and its authors: Devan Schlund1, Jennifer Poirier2, Anuradha R Bhama3, Dana Hayden3, Theodore Saclarides3, Bruce Orkin4, Joanne Favuzza5.

[2:28] How ɫ��ֱ�� partneredwith Rush in late 2016 for their colorectal ERAS program and why the main goalof this study was to determine the impact of ɫ��ֱ�� on ERAS compliance &clinical outcomes (length of stay, readmissions, surgical site infections,total cost of care) since the Length of Stay improvements had plateaued for theERAS program;

[9:18] How participantsincluded all patients undergoing colorectal ERAS surgery between February 2017and July 2018, regardless of whether they opted into the phone application;

[9:40] How patients wouldreceive a patient education booklet provided by trained nurses during apre-operative clinical visit and how they would consent for ɫ��ֱ��following this clinic visit;

[11:10] How 289 patients wereenrolled in the study (147 patients with ɫ��ֱ�� and 142 without);

[12:11] How ERAS compliancewas measured for oral intake, solid food intake, % of patients completing bowelprep, and % of patients adhering to ERAS medication;

[12:20] Discussing ERAS Compliance Results:

Oral & solid food intake: No significant change between groups, however, patients with ɫ��ֱ�� were trending in the right direction;

Bowel prep completion: 74.8% of patients did bowel prep with ɫ��ֱ�� vs. 66.2% without (p=0.059);

ERAS medication adherence: 82.1% with ɫ��ֱ�� vs. 76.8% without (p=0.005);

[14:14] Why patientsmight be more compliant with ERAS protocols using digital patient engagement sincethe patient journey is complex and technology helps to distill information intobite-sized pieces and explains context for each protocol (e.g. why bowel prepis important for surgery);

[20:27] Discussing Clinical Outcomes Results:

Readmission rates: No significant variance between groups;

(There was no remotepatient monitoring enabled, which is a strong factor in influencing change inreadmission rates as seen by other ɫ��ֱ�� partners);

Surgical site infections (SSIs): 70% reduction in SSIs with ɫ��ֱ�� (p=0.019); (3.4% of patients had SSI with ɫ��ֱ�� vs. 11.3% had SSI without ɫ��ֱ��);

Length of stay: 2.0 days reduction in mean length of stay with ɫ��ֱ�� (p=0.006); (4.4 days avg. with ɫ��ֱ�� vs. 6.4 days avg. without);

Total cost of care: $2,386 reduction in total cost of care with ɫ��ֱ�� (p=0.024);

($11,560 avg. cost withɫ��ֱ�� vs. $13,946 avg. cost without);

[24:00] Why clinical outcomes may have improved with ɫ��ֱ�� because of increased patient compliance to ERAS elements such as the chlorhexidine wash before surgery which would have impacted SSI rates;

[29:09] Discussing the studylimitations:

1. Small sample size(only conducted at one medical institution);

2. Lack of randomization(due to opt-in nature of study);

3. Did not measurecompliance to all ERAS components;

4. (Not a studylimitation but a technological limitation) The group took a hands-off approach anddid not utilize ɫ��ֱ��’s remote patient monitoring capabilities which mayhave reduced readmissions;

1 Department of General Surgery, Rush University Medical Center,
Chicago, IL, USA

2 Rush Alzheimer’s Disease Center, Rush University Medical Center,
Chicago, IL, USA

3 Department of General Surgery, Division ofColon and Rectal
Surgery, Rush University Medical Center, Chicago, IL, USA

4 Advent Health Center for Colon and RectalSurgery, University of
Central Florida, Orlando, FL, USA

5 Department of Surgery, Division of Colon andRectal Surgery,
Boston Medical Center, FGH Building 820 Harrison Avenue, Room
5008, Boston, MA 02118, USA