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

Abstract

BackgroundSurgical 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.ObjectiveDrawing 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.MethodsWe 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.ResultsPrimary 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.ConclusionsHealth 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 RegistrationClinicaltrials.gov NCT02735525; https://clinicaltrials.gov/ct2/show/NCT02735525 (Archived by WebCite at http://www.webcitation.org/6oIvN4Mab)

Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey

“…When we inquired about applied uses, respondents emphasized the use of apps as a communication tool and, although the amount of data we obtained did not allow for deep analysis, a significant number of professionals claimed to have sent patient images or photographs to other colleagues and a small percentage had sent clinical information. Some studies carried out with mobile phones mentioned that telemedicine offers an opportunity to send photos and video clips, representing a source of clinical support for obtaining a second opinion from other colleagues and experts [30,31]. In an environment of scarce resources, the use of mobile phones for medical communication could be of great value.…”

“…The use of SNSs as a means of communicating with patients has been reported as being of little use, probably, according to other studies, due to the lack of legal protection, because their use could be a source of errors or distractions [32], or because of the preference for face-to-face contact with their physicians by a large part of the population [33]. This trend could change in the near future, as pointed out by some studies carried out in places where mobile phones are mostly used, since it can improve patient care and make the use of resources more efficient [29-31,34].…”

A pilot feasibility randomised clinical trial comparing dialkylcarbamoylchloride‐coated dressings versus standard care for the primary prevention of surgical site infection

“…More contemporary technology might be used during a clinical trial to improve communication with patients and avoid in‐person attendances for follow‐up data collection . Prior examples of remote follow up are already being reported in clinical trials, and in routine clinical practice . Specific work aimed at identifying SSIs using remote technology is already underway .…”

Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults

“…9,35 Although research in this area is currently bourgeoning, much of this work has focused on the use of personal mobile devices for telemedicine (triage, consultation, and diagnosis) [36][37][38] and remote wound monitoring. 39,40 Less work is focused on using photography to increase accuracy and detail of documentation of physical findings, though this has been recognized in the field of dermatology. 41 Continued work in this area will be valuable to inform how photography using mobile devices can be effectively incorporated into medical encounters and contribute to improved medical documentation.…”