Surgical site infection (SSI) is the most common nosocomial infection in surgical patients and accounts for 38% of post-operative complications. SSI and additional wound complications result in physical and emotional stress for a significant number of patients and their families and can lead to readmission, reoperation, limb loss, or death. Wound complications also produce increased health care costs, and we have found that SSI is the leading cause of unplanned, potentially preventable hospital readmissions for surgical patients. If diagnosed at an early stage, SSI can be treated in the outpatient setting with oral antibiotics and wound care, precluding the need for readmission, intravenous antibiotics, and reintervention. However, patients rarely recognize early stage wound infections and often present with an advanced infection that requires intensive treatment and rehospitalization. Interventions have been employed to prevent SSI in the inpatient setting, but the majority of wound infections (up to 84%) develop in the interval following hospital discharge and prior to routine follow-up. The importance of the outpatient setting makes transitional care coordination an important focus in the management of SSI. Patient-centered interventions to improve transitional care for surgical patients are absent from the literature and routine practice but hav the potential to stem the burden of SSI and readmissions in this complex patient population. We will address this gap with a patient-centered, outpatient wound surveillance program using Smartphone-digital photography designed to promote early recognition of SSI following discharge. Evaluations of personal digital assistant (PDA) and touch-based technological interfaces for older adults have produced very encouraging results. Moreover, smartphone data plans permit the transmission of information without an Internet connection or WiFi hotspot. We hypothesize that (1) photo and in-person assessments of wounds are equivalent in detecting wound complications, (2) with proper training and support, patients/caregivers will be capable of routinely utilizing smartphone technology to photograph and transfer digital pictures of their postoperative wounds, and (3) a well-designed outpatient wound surveillance program can empower patients to monitor their wounds, lead to early diagnosis of wound complications, and prevent readmission and potentially life threatening complications. We focus on vascular surgery because this population has the highest readmission rate among surgical specialties, most commonly for SSI. Vascular surgery also has the highest projected demand growth among medical specialties (31% by 2025) after adjusting for expanded coverage under the Patient Protection and Affordable Care Act.
In Aim 1, we determine whether health care providers/surgeons can differentiate between infected and normally healing wounds using a Smartphone digital photograph and a standardized evaluation adapted from the CDC.
In Aim 2, we design and evaluate the three major components of a patient centered Outpatient Wound Surveillance Program (OWSP): A) Application (App) Design for a Web-based Smartphone, B) Training Module Design for patients or caregivers to photograph and transmit Smartphone images of their postoperative wounds, and C) Create methodology for assimilation and review of data by a surgical service.
In Aim 3, we combine the three components and pilot test the full patient centered OWSP with a targeted enrollment of 40 patients. Our goal in completing this application is to be prepared to implement the intervention as a multicenter, randomized controlled trial. Our work will ultimately improve transitional care for surgical patients and connect patient-centeredness to post-operative care.
Surgical site infection (SSI) is the most common hospital-acquired infection in surgical patients and accounts for 38% of post-operative complications. The US Department of Health and Human Services Action Plan to Prevent Healthcare-Associated Infections has made reducing SSI a national priority. Similarly, the Centers for Disease Control and Prevention Division of Healthcare Quality Promotion subscribes to a 5-year target of reducing SSI by 25%. Furthermore, a significant proportion of SSI occurs after discharge. Our project seeks to reduce the burden of SSI following discharge through a patient- centered program in which patients submit daily smartphone photos of their wound to the surgical service for prompt review. Our work has the potential to improve transitional care and stem the burden of SSI for surgical patients.