Patient-Centered Postoperative Wound Surveillance Using Current Technology

Surgical site infection (SSI) is the most common hospital-acquired infection and accounts for 38 percent of post-operative complications. In addition to increased healthcare costs, SSI results in physical and emotional stress for patients and their families and can lead to readmission, reoperation, limb loss, or death. A significant proportion of SSIs occur after the patient has gone home, placing significant burden on the patient and their caregivers who don’t know how to recognize SSI, leading to delayed diagnosis and consequently increasing risks for morbidity and complex and costly treatment. However, if diagnosed at an early stage, SSI can often be treated in the outpatient setting with oral antibiotics and wound care, precluding the need for readmission.

Investigators developed a patient-centered smartphone application called the Outpatient Wound Surveillance Program (OWSP). While previous interventions have focused on SSI prevention, OWSP concentrated on early diagnosis using patient-submitted photographs. Because a quarter of vascular surgery patients are readmitted within 30 days of surgery, they were the target of the intervention.

The specific aims of the project were as follows:

• Determine whether healthcare providers and surgeons can differentiate between infected or complicated wounds and normally healing wounds using a smartphone digital photograph. 
• Design and evaluate the three major components of a patient-centered OWSP. 
• Pilot test the full patient-centered OWSP. 

Researchers developed the OWSP application and pilot tested its usability among postoperative vascular inpatients. Using feedback from the pilot, researchers re-designed the application and then recruited postoperative patients to use the application at home. Participants were trained and asked to transmit photographs of their wound and a brief survey regarding their recovery daily for 14 days. Nurse practitioners and physicians reviewed the photograph submissions and survey responses on fever, pain, and wound drainage, within 24 hours.

Findings indicated that vascular surgery patients were willing to participate in post-operative mobile health programs and able to complete the program with a high level of fidelity and satisfaction, and that digital images provided sufficient information to make first-line treatment decisions. Usability testing found that 81.8 percent of images were sufficient for diagnosis and that user satisfaction had an average score of 83.3 out of 100. Preliminary results indicated the ability to detect and intervene on wound complications at earlier stages, preventing hospital readmission. Of the eight SSIs found in the patient cohort, seven were detected using images and survey responses from the application. The researchers concluded that programs such as OWSP are easily integrated into existing service lines and may not add a significant additional burden to patients or providers.