Feasibility of Implementing a Patient-Centered Postoperative Wound Monitoring Program Using Smartphone Images: A Pilot Protocol

Sara Fernandes-Taylor, Rebecca L Gunter, Kyla M Bennett, Lola Awoyinka, Shahrose Rahman, Caprice C Greenberg, K Craig Kent, Sara Fernandes-Taylor, Rebecca L Gunter, Kyla M Bennett, Lola Awoyinka, Shahrose Rahman, Caprice C Greenberg, K Craig Kent

Abstract

Background: Surgical site infections (SSI) represent a significant public health problem as the most common nosocomial infection and a leading cause of unplanned hospital readmissions among surgical patients. Many develop following hospital discharge and often go unrecognized by patients. Telemedicine offers the opportunity to leverage the mobile technology to remotely monitor wound recovery in the transitional period between hospital discharge and routine clinic follow-up. However, many existing telemedicine platforms are episodic, replacing routine follow-up, rather than equipped for continued monitoring; they include only low-risk patient populations and those who already have access to and comfort with the necessary technology; and transmit no visual information.

Objective: Drawing upon the Coleman model for care transitions and the Proctor model for implementation, we propose a protocol of postoperative wound monitoring using smartphone digital images. In this study, we will establish the feasibility of such a program, both for patients and for the clinical care team.

Methods: We will recruit 40 patients or patient/caregiver pairs from our inpatient vascular surgery service. Eligible patients will be English-speaking, 18 years of age or older, and have an incision at least 3 cm in length. Participants will receive a training session, during which they will learn to use the device and the wound monitoring smartphone app. Following hospital discharge, they will submit digital images of their wound and responses to a survey about their recovery for 14 days. Experienced health care providers on the vascular surgery inpatient service will review transmitted data daily and contact patients for any concerning findings.

Results: Primary outcomes will include participant adherence to the protocol, time required for providers to review submissions, time from submission to provider review, and participant satisfaction. Secondary outcomes will include SSI detection and hospital readmission.

Conclusions: Health systems are increasingly dedicating efforts to transitional care improvement programs. This feasibility trial will confirm whether patients and their caregivers can learn to use a postdischarge wound monitoring smartphone app and will assess patient and provider satisfaction. This protocol will provide preliminary evidence for a shift in the delivery of postdischarge care in a patient-centered and cost-effective manner.

Trial registration: Clinicaltrials.gov NCT02735525; https://ichgcp.net/clinical-trials-registry/NCT02735525 (Archived by WebCite at http://www.webcitation.org/6oIvN4Mab).

Keywords: clinical research protocol; feasibility study; smartphone; surgical site infection; telemedicine; transitional care.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sara Fernandes-Taylor, Rebecca L Gunter, Kyla M Bennett, Lola Awoyinka, Shahrose Rahman, Caprice C Greenberg, K Craig Kent. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 22.02.2017.

Figures

Figure 1
Figure 1
Conceptual model of implementation research. Reprinted with permission from Procter et al [20].
Figure 2
Figure 2
WoundCheck iOS app: image taking and survey sample screenshots. Picture from Shutterstock.
Figure 3
Figure 3
WoundCheck workflow.

References

    1. Mangram A, Horan T, Pearson M, Silver L, Jarvis W. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999 Apr;20(4):250–278. doi: 10.1086/501620.
    1. Kirkland K, Briggs J, Trivette S, Wilkinson W, Sexton D. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999 Nov;20(11):725–730. doi: 10.1086/501572.
    1. Wiseman J, Guzman A, Fernandes-Taylor S, Engelbert T, Saunders R, Kent K. General and vascular surgery readmissions: a systematic review. J Am Coll Surg. 2014 Sep;219(3):552–569. doi: 10.1016/j.jamcollsurg.2014.05.007.
    1. Perencevich E, Sands K, Cosgrove S, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003 Feb;9(2):196–203. doi: 10.3201/eid0902.020232.
    1. Morris M, Deierhoi R, Richman J, Altom L, Hawn M. The relationship between timing of surgical complications and hospital readmission. JAMA Surg. 2014 Apr;149(4):348–354. doi: 10.1001/jamasurg.2013.4064.
    1. Whitby M, McLaws Ml, Collopy B, Looke DFL, Doidge N, Henderson B, Selvey L, Gardner G, Stackelroth J, Sartor A. Post-discharge surveillance: can patients reliably diagnose surgical wound infections? J Hosp Infect. 2002 Nov;52(3):155–160.
    1. Whitby M, McLaws ML, Doldge S, Collopy B. Post-discharge surgical site surveillance: does patient education improve reliability of diagnosis? J Hosp Infect. 2007;66(3):237–242. doi: 10.1016/j.jhin.2007.04.014.
    1. Medicare Hospital Readmissions Reduction Program. Centers for Medicare and Medicaid Services; 2016. Apr 18, [2017-02-14]. .
    1. Kassin M, Owen R, Perez S, Leeds I, Cox J, Schnier K, Sadiraj V, Sweeney JF. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012 Sep;215(3):322–330. doi: 10.1016/j.jamcollsurg.2012.05.024.
    1. Brooke B, De Martino RR, Girotti M, Dimick J, Goodney P. Developing strategies for predicting and preventing readmissions in vascular surgery. J Vasc Surg. 2012 Aug;56(2):556–562. doi: 10.1016/j.jvs.2012.03.260.
    1. Gunter R, Chouinard S, Fernandes-Taylor S, Wiseman J, Clarkson S, Bennett K, Greenberg CC, Kent KC. Current use of telemedicine for post-discharge surgical care: a systematic review. J Am Coll Surg. 2016 May;222(5):915–927. doi: 10.1016/j.jamcollsurg.2016.01.062.
    1. Matousek A, Paik K, Winkler E, Denike J, Addington SR, Exe C, Louis RR, Riviello R. Community health workers and smartphones for the detection of surgical site infections in rural Haiti: a pilot study. Lancet. 2015 Apr 27;385 Suppl 2:S47. doi: 10.1016/S0140-6736(15)60842-X.
    1. Pathak A, Sharma S, Sharma M, Mahadik V, Lundborg CS. Feasibility of a mobile phone-based surveillance for surgical site infections in rural India. Telemed J E Health. 2015 Nov;21(11):946–949. doi: 10.1089/tmj.2014.0199.
    1. Semple J, Sharpe S, Murnaghan M, Theodoropoulos J, Metcalfe K. Using a mobile app for monitoring post-operative quality of recovery of patients at home: a feasibility study. JMIR Mhealth Uhealth. 2015 Feb 12;3(1):e18. doi: 10.2196/mhealth.3929.
    1. Rao R, Shukla B, Saint-Cyr M, Rao M, Teotia S. Take two and text me in the morning: optimizing clinical time with a short messaging system. Plast Reconstr Surg. 2012 Jul;130(1):44–49. doi: 10.1097/PRS.0b013e3182547d63.
    1. Vassilev I, Rowsell A, Pope C, Kennedy A, O'Cathain A, Salisbury C. Assessing the implementability of telehealth interventions for self-management support: a realist review. Implement Sci. 2015;10 doi: 10.1186/s13012-015-0238-9.
    1. Wiseman J, Fernandes-Taylor S, Barnes M, Tomsejova A, Saunders R, Kent K. Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology. J Surg Res. 2015 Sep;198(1):245–251. doi: 10.1016/j.jss.2015.05.011.
    1. Wiseman J, Fernandes-Taylor S, Gunter R, Barnes M, Saunders R, Rathouz P, Yamanouchi D, Kent KC. Inter-rater agreement and checklist validation for postoperative wound assessment using smartphone images in vascular surgery. J Vasc Surg Venous Lymphat Disord. 2016 Jul;4(3):320–328. doi: 10.1016/j.jvsv.2016.02.001.
    1. Gunter R, Fernandes-Taylor S, Mahnke A, Awoyinka L, Schroeder C, Wiseman J, Sullivan S, Bennett K, Greenberg C, Kent KC. Evaluating patient usability of an image-based mobile health platform for postoperative wound monitoring. JMIR Mhealth Uhealth. 2016 Sep 28;4(3):e113. doi: 10.2196/mhealth.6023.
    1. Proctor E, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2009 Jan;36(1):24–34. doi: 10.1007/s10488-008-0197-4.
    1. Engelbert T, Fernandes-Taylor S, Gupta P, Kent K, Matsumura J. Clinical characteristics associated with readmission among patients undergoing vascular surgery. J Vasc Surg. 2014 May;59(5):1349–1355. doi: 10.1016/j.jvs.2013.10.103.
    1. Coleman E, Parry C, Chalmers S, Min S. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006 Sep 25;166(17):1822–1828. doi: 10.1001/archinte.166.17.1822.
    1. Parry C, Kramer HM, Coleman EA. A qualitative exploration of a patient-centered coaching intervention to improve care transitions in chronically ill older adults. Home Health Care Serv Q. 2006;25(3-4):39–53. doi: 10.1300/J027v25n03_03.
    1. Parry C, Coleman E, Smith J, Frank J, Kramer A. The care transitions intervention: a patient-centered approach to ensuring effective transfers between sites of geriatric care. Home Health Care Serv Q. 2003;22(3):1–17. doi: 10.1300/J027v22n03_01.
    1. Rutherford P, Nielsen G, Taylor J, Bradke P, Coleman E. How-to guide: improving transitions from the hospital to community settings to reduce avoidable rehospitalizations. Cambridge: Institute for Healthcare Improvement; 2013. [2017-02-15]. .
    1. Pesce C, Guidetti L, Baldari C, Tessitore A, Capranica L. Effects of aging on visual attentional focusing. Gerontology. 2005;51(4):266–276. doi: 10.1159/000085123.
    1. Wlodkowski R. Enhancing Adult Motivation to Learn: A Comprehensive Guide for Teaching All Adults. Hoboken: Wiley; 2008.
    1. Balota D, Dolan P, Duchek J. Memory changes in healthy older adults. In: Tulving E, Craik FIM, editors. Oxford Handbook of Memory. Oxford: Oxford University Press; 2000.
    1. Bird M, Kinsella G. Long-term cued recall of tasks in senile dementia. Psychol Aging. 1996 Mar;11(1):45–56.
    1. Vaportzis E, Georgiou-Karistianis N, Stout J. Dual task performance in normal aging: a comparison of choice reaction time tasks. PLoS One. 2013;8 doi: 10.1371/journal.pone.0060265.
    1. National Nosocomial Infections Surveillance System National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004 Dec;32(8):470–485. doi: 10.1016/S0196655304005425.
    1. Cutting K, White R. Defined and refined: criteria for identifying wound infection revisited. Br J Community Nurs. 2004 Mar;9(3):S6–S15. doi: 10.12968/bjcn.2004.9.Sup1.12495.
    1. Jencks S, Williams MV, Coleman E. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 02;360(14):1418–1428. doi: 10.1056/NEJMsa0803563.
    1. Dall T, Gallo P, Chakrabarti R, West T, Semilla A, Storm MV. An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Affairs. 2013 Nov 04;32(11):2013–2020. doi: 10.1377/hlthaff.2013.0714.
    1. International Standards Organization (ISO) ISO 9421-12 Ergonomic requirements for office work with visual display terminals (VDTs)—Part 12: Presentation of information. 2016. [2017-02-15]. .
    1. Frampton S, Guastello S, Brady C, Hale M, Horowitz S, Bennett Smith S. Patient-centered care improvement guide. 2008. [2017-02-15]. .
    1. James J. Health Policy Brief: Medicare Hospital Readmissions Reduction Program. Health Affairs; 2013. Nov 12, [2017-02-15]. .
    1. American College of Surgeons S-CAHPS (Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey) 2016. [2017-02-15]. .
    1. Jack B, Chetty V, Anthony D, Greenwald J, Sanchez G, Johnson A, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009 Feb 03;150(3):178–187.

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