Virtual Care of Acute Diverticulitis: A Phase I/II Randomised Clinical Feasibility Trial

BACKGROUND: Acute uncomplicated diverticulitis is commonly managed in hospital in Australia. Virtual care may offer reassurance to clinicians and enable out-of-hospital management by providing remote monitoring. This study evaluated the feasibility, safety and acceptability of a virtual care pathway for acute diverticulitis (iCAD). METHODS: This Phase I/II trial comprised a single-centre pilot of patients managed via the iCAD pathway, followed by a multicentre randomised trial comparing iCAD with conventional inpatient care. The iCAD model involved initial in-person assessment and intravenous antibiotics, followed by daily medical/nursing videoconferencing, supported by wearable devices and a mobile app for vital signs monitoring. Outcomes included treatment retention (defined as the proportion of patients who remained on the iCAD pathway without crossover to inpatient care), rate of major complications and patient-reported acceptability. RESULTS: In Phase I, 10 participants were treated on the iCAD pathway with no withdrawals, crossovers or major complications. In Phase II, 40 patients were randomised and no major complications occurred in either group. Two iCAD patients crossed over to inpatient care for clinical reasons. The treatment retention rate for the virtual care group across both phases of the trial was 93%. Patient-reported experiences favoured the iCAD group, with more participants rating their care as 'excellent' (88% vs. 40%, p = 0.03) and felt their healthcare needs were 'always' met (88% vs. 47%, p = 0.02). CONCLUSIONS: Virtual care for acute uncomplicated diverticulitis appears feasible, safe and acceptable, with potential advantages over inpatient care, including superior patient-reported experience.