REMINDers for Incentive Spirometry in PACU (REMIND-IS in PACU)

Not Applicable

Completed

Conditions: Postoperative Hypoxemia
Postoperative Atelectasis
Postoperative Pulmonary Complications
Respiratory Insufficiency
Patient Adherence
Postoperative Pneumonia
Incentive Spirometry
Respiratory Therapy

Brief Summary: The purpose of this study is to determine if the frequency of use of incentive spirometry during the stay in the Post-Anesthesia Care Unit (PACU) increases with visual and auditory electronic reminders, as compared to not having those reminders.

Detailed Description: This is a pragmatic single-center alternating cluster study. We will enroll adult patients who require general anesthesia for surgery and receive an incentive spirometry device during their PACU stay. Automatic alarms to perform incentive spirometry will be set to either "ON" or "OFF" in alternating weeks. The hypothesis is that patients receiving automatic audible and visual alarms will have increased rates of adequate incentive spirometry breaths compared to patients receiving no alarms.

Recruitment & Eligibility

Inclusion Criteria

be 18 years or older;
have undergone a surgical procedure at the University of Colorado Hospital under general anesthesia;
have incentive spirometry ordered by their provider, or incentive spirometry must be part of the study site's standard-of-care which is implemented by hospital staff;
not have severe hearing or impaired visual acuity deficiency, in that they cannot hear or see the audible and visual signal of the InSee monitor.

Exclusion Criteria

have a severe hearing or visual acuity impairment that prevents them from hearing or seeing the audible and visual signals of the InSee monitor;
have the inability to perform incentive spirometry due to refusal, cognitive impairment, neuromuscular weakness, anatomical or any other reasons (e.g., tracheotomy, oral surgery, unable to hold incentive spirometry device);
are a part of a vulnerable population (e.g., pregnant, minors, prisoners).

Arm && Interventions

Group	Intervention	Description
Alarm "ON" Cohort	Alarms	The "ON" cohort will receive the standard-of-care instructions for IS and information about the auditory and visual reminders. The "ON" cohort patients will receive audible and visual signals from the InSee monitor attached to their incentive spirometer every 20 minutes and upon successfully reaching certain achievements.
Alarm "OFF" Cohort	Alarms	The "OFF" cohort will receive only the standard-of-care instructions for IS. The "OFF" patients will receive no signals from the InSee monitor attached to their incentive spirometer.

Primary Outcome Measures

Name	Time	Method
Rate of adequate IS breaths achieved in PACU	PACU stay (up to 3 hours)	Rate of adequate incentive spirometry breaths achieved by patients per hour for up to 3 hours during the PACU stay

Secondary Outcome Measures

Name	Time	Method
Time to first adequate IS breath	PACU stay (up to 3 hours)	The time it takes for the patient to achieve their first adequate IS breath, from the moment of being provided the IS device and instructions of use onward, during their PACU stay
Rate of IS breaths attempted in PACU	PACU stay (up to 3 hours)	Rate of incentive spirometry breaths attempted by patients per hour for up to 3 hours during the PACU stay
Duration of postoperative O2 therapy	Hospital stay (up to first 3 postoperative days)	The total postoperative length of oxygen therapy use from the time the patient arrives to PACU to the end of their O2 therapy
Need for ICU Admission after PACU	Hospital stay (up to first 3 postoperative days)	The frequency of patients requiring ICU admission immediately after their PACU stay
Presence of postoperative pulmonary complications	Hospital stay (up to first 3 postoperative days)	The number of study participants developing any pulmonary complications (including pneumonia, need for non-invasive ventilation (CPAP/BiPAP or reintubation for any reason and any duration) during the first 3 postoperative days
PACU Length of Stay	PACU stay	The length of stay in the PACU
Individual postoperative pulmonary complications	Hospital stay (up to first 3 postoperative days)	The number of study participants developing each pulmonary complication (pneumonia, need for non-invasive ventilation (CPAP/BiPAP or reintubation for any reason and any duration) during the first 3 postoperative days