New Juravinski Research Institute projects aim to transform the health system in Hamilton and beyond

Less pain after surgery. Fewer admissions to the emergency department. Greater access to digital medical records. More opportunities for virtual visits and at-home monitoring. Decreased medication errors. These are just some of the revolutionary changes to the health system that researchers are aiming to implement in Hamilton.

Thanks to a $3 million donation from Charles and Margaret Juravinski, the Juravinski Research Institute (JRI) has funded five new research projects across Hamilton Health Sciences, McMaster University and St. Joseph’s Healthcare Hamilton — all centred around health system transformation.

Health system transformation involves using innovative approaches to create a more integrated and efficient health care system. The delivery of innovative and transformative care, including remote and virtual services, has become especially important amidst the COVID-19 pandemic.

“The researchers at our three organizations are working together to discover ways to help patients in Hamilton and beyond encounter fewer barriers to care,” said Dr. Julian Dobranowski, chair of the JRI’s scientific and steering committees.

The new JRI projects feature researchers from Hamilton Health Sciences, McMaster University and St. Joseph’s Healthcare Hamilton working collaboratively to digitize health records, prioritize e-health and advance technology to create a “digital first” approach to patients’ health care.

The health system transformation projects are:

Post-surgery virtual care with remote automated monitoring technology-2 (PVCRAM-2) trial

What is it? Building upon the results of a previous study, the PVCRAM-2 trial is a randomized trial looking at whether managing surgical patients after discharge by using virtual care with Remote Automated Monitoring (RAM) prevents the need for patients to come back to the emergency room or be re-admitted to the hospital compared to normal follow-up after hospital discharge without virtual care and RAM.

RAM refers to the use of technology to remotely monitor patients’ biophysical parameters (e.g., blood pressure, temperature).

Why does it matter? In a recent major study, 25 per cent of patients required acute-hospital care (i.e., hospital readmission or emergency department visit) within 30 days after discharge home following major surgery. Promising data suggests that virtual care with RAM will reduce the need for patients to return to hospital after undergoing major surgery.

How does it work? Patients being discharged home after major surgery will be randomized to virtual care with RAM or standard follow-up care. The RAM technology will measure six factors: blood pressure, heart rate, respiratory rate, oxygen saturation, temperature and weight. These will be monitored by nurses virtually who will have scheduled video visits with the patient and will escalate care to a physician when necessary.

Who’s doing it? The lead investigators are Dr. PJ Devereaux, director of Division of Perioperative Care, Department of Health Research Methods, Evidence, and Impact, McMaster University and Michael McGillion, PhD, assistant dean, research, School of Nursing, McMaster University.

Multidisciplinary virtual wound service for lower extremity wounds

What is it? A multidisciplinary virtual model of care for lower extremity wounds for Hamilton patients that is sustainable, effective and cost efficient.

Why does it matter? Chronic lower extremity wounds pose significant challenges for patients and the health care system, including the management of chronic conditions such as renal (kidney) failure and surgical interventions. It is imperative that evidence-based, clinical-based practices are implemented to provide organization and community-wide support for this vulnerable patient population.

How does it work? This model will leverage virtual care platforms to increase access for patients and minimize hospital visits. Ongoing follow up of patients’ wounds can be performed with a mobile application that takes photos and processes them to allow care providers to monitor progress. A nurse coordinator would provide the initial virtual visit, testing and patient education. Subsequent specialist visits would be arranged according to the patients’ care needs. The types of wound dressings used would be in a gradual fashion to promote healing while balancing costs. Within this virtual wound care service, the questions of patient registration, attendance, and participation until wound healing, wound healing times and adherence to recommendations will be assessed.

Who’s doing it? The lead investigator is Dr. Fadi Elias, assistant professor of vascular surgery, Hamilton Health Sciences and McMaster University.

Innovating in virtual care: Continuing emergency department virtual care in southwestern Ontario providing infrastructure for virtual care city-wide and establishing a virtual care centre of excellence

What is it? This project provides a first-to-market application of outpatient urgent medical care and the first provincial model of regional urgent medical care. It aims to use digital health applications to aid with the remote triage of patients, evenly distribute them across the urgent care spectrum, move their data automatically into the in-person emergency department chart and allow appropriate patients to begin their emergency department wait at home. Additional goals include establishing a centre of excellence in virtual care at St. Joseph’s and answering some pressing questions surrounding the delivery of virtual care.

Why does it matter? Without a doubt, the proliferation, adoption and integration of virtual care has been the single largest health system transformation that has resulted from the COVID-19 pandemic. This digital health application has the potential to revolutionize both remote and in-person triage, leading to reduced human health resource demands, expedited triage, explicit direction to patients based on health care needs and could offset demand across the city, thereby decreasing emergency room wait times.

How does it work? The mobile application is integrated with the Electronic Medical Record (EMR) which allows patients to register for care from home. The project is seeking a solution that would direct emergent cases to the Emergency Department (ED) immediately for care with pre-registration. For lower acuity patients, they could wait for care at home and be directed to the ED for triage when the ED team is ready. This would be integrated to also triage patients suitable for virtual visits vs. in-person visits.

Who’s doing it? The lead investigator is Dr. Shawn Mondoux, quality and safety lead in the Emergency Department at St. Joseph’s Healthcare Hamilton and assistant professor in the Department of Medicine, McMaster University.

Development, validation and clinical testing of AI-guided infrared camera alerting system (AIR alert)

What is it? A special infrared (IR) camera system will be created using machine learning (also known as artificial intelligence) to monitor vital signs, including heart rate, blood pressure, temperature, breathing rate and blood oxygen level. This system will be used to detect changes in vital signs and alert health care providers when a patient may need rapid medical attention.

Why does it matter? This research could revolutionize how vital signs are detected. Touchless patient assessments would be more comfortable and convenient, reduce the risk of spreading infection and make it easier to monitor patients remotely. Further, health outcomes could be improved through earlier detection of patients with worsening vital signs.

How does it work? A computer model that determines vital signs based on IR camera data will be developed using vital sign measurements we receive from patients with various face shapes, skin tones, sexes and health statuses. Once an accurate system is developed, it will be tested in a clinical study that will compare it to Early Warning Scores (EWS) already being used to alert Rapid Response Teams (RRTs). Since the camera-based intervention will obtain vital signs more readily than traditional methods and use artificial intelligence to detect change, it is believed to result in patients getting earlier medical attention and having better outcomes.

Who’s doing it? The lead investigator is Dr. Dan Perri, an associate professor of medicine at McMaster University, and the chief medical information officer and a critical care physician at St. Joseph’s Healthcare Hamilton.

Towards a digital diagnostics suite for reducing hospital admissions in vulnerable patients with chronic kidney or respiratory disease

What is it? A study examining new methods of delivering at-home, remote care with the goal of improving health and preventing frequent hospital admissions for patients with chronic disease. The research team will develop and test a method of assessing blood markers at home to help guide both patients and the health care team to deliver tailored interventions.

Why does it matter? Some individuals living with chronic disease need close monitoring and are at high risk for admissions to hospital. The COVID-19 pandemic has reduced access to care and reduced the frequency of in-person visits with health care providers. This has changed the way that health care is delivered and has created a shift toward more remote, at-home care.

How does it work? A large, multidisciplinary study team, including members from physiotherapy, psychology, biochemistry, engineering, respirology and nephrology, will focus on patients living with chronic kidney or lung disease. They will test if using technology to closely monitor patients at home and deliver enhanced virtual care, such as physiotherapy and counseling, will improve measures of health and reduce hospital visits or admissions.

Who’s doing it? The lead investigators are Dr. Amber Molnar, nephrologist and Dr. Ciaran Scallan, respirologist, both of St. Joseph’s Healthcare Hamilton.

Visit the Juravinski Research Institute website or follow the institute on Twitter at @JuravinskiRI to learn more about these projects.

The JRI is improving the health of Canadians by advancing groundbreaking research at Hamilton Health Sciences, McMaster University and St. Joseph’s Healthcare Hamilton. The institute and its projects are funded through the generosity of Hamilton philanthropists, Charles and Margaret Juravinski. Join Charles and Margaret in making a lasting legacy to pioneering health research by donating in support of the JRI.