R. Gunter1, S. Fernandes-Taylor1, S. Rahman1, L. Awoyinka1, K. Bennett1, C. Greenberg1, K. C. Kent2 1University Of Wisconsin,Wisconsin Institute Of Surgical Outcomes Research,Madison, WI, USA 2University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction:
Surgical site infection is the most common nosocomial infection and a leading cause of unplanned hospital readmission among surgical patients. Many of these infections develop in the critical interval between hospital discharge and routine follow-up. If diagnosed at an early stage, SSI can often be treated in the outpatient setting. However, patients rarely recognize early stage wound infections causing them to present with an advanced infection requiring rehospitalization or operative reintervention. An intervention to prevent these catastrophic consequences would represent a substantial improvement in patient care. To address this, we developed and pilot tested a mobile health application (app) and protocol of remote wound monitoring using smartphones for vascular surgery patients at a large tertiary care academic institution.
Methods:
We are currently recruiting 40 patients following vascular surgery. Eligible patients are 18 years of age or older with an incision at least 3 cm in length. Patients participate in a training session to learn to use the iPhone and the wound monitoring app. Following hospital discharge, patients send digital images of their wound and responses to a short survey daily for two weeks. Experienced healthcare providers on the vascular surgery service review these submissions daily and contact patients for any concerning findings. We will present final results, if accepted.
Results:
Since June 2016, 89 patients have been screened, 41 of whom were eligible for participation. Twenty-eight have consented to participate and been enrolled (68% consent rate). Fifty-four percent of participants were novice smartphone users. Participants completed training in an average 16.5 minutes, with an average system usability score of 85.2 (scale 0-100). Fifty-five percent of participants submitted data every day, with an average of 1 day missed per participant. A provider reviewed submissions an average of 9.4 (range 0.1-51.6) hours after submission. Review took an average 2.3 (range 1-33) minutes per patient, with an average total 7.9 (range 1-39) minutes per day. Three participants were readmitted, two of whom fell on amputation stumps. Two early wound infections were detected using submitted images and treated on an outpatient basis; no wound infections developed undetected in monitored sites. Patient satisfaction has been universally high upon completion.
Conclusion:
Vascular surgery patients and their caregivers are willing to participate in a mobile health program aimed at remote monitoring of postoperative recovery, and they are able to complete the program with a high level of fidelity and satisfaction. Such a program is easily integrated into existing service lines and does not add a significant clinical burden. Preliminary results indicate the ability to detect and intervene on wound complications at earlier stages and prevent hospital readmission and potentially catastrophic wound complications.