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Phone App enables Postoperative Wound Monitoring, Reducing Readmissions and Improving care

A study released last year 2018 says patients gave universally positive feedback about a smartphone app, called WoundCheck, and its ease of use for monitoring wounds.  The app, developed by researchers from the Wisconsin Institute of Surgical Outcomes Research (WiSOR), department of surgery, University of Wisconsin, Madison, enables patients to remotely send images of their surgical wounds for monitoring by nurses. Earlier detection of surgical site infections (SSIs) can prevent hospital readmissions. The wound monitoring app study findings appeared in the March 2018 issue of the Journal of the American College of Surgeons.

Tracking Wounds to Reduce Readmission to Hospitals Photo Credit: Laboratory Equipment

According to the researchers, SSIs are the most common hospital-acquired infection and the leading cause of hospital readmission following an operation. Due to the increased incidence of SSIs, the WiSOR research team decided to see if postoperative wound monitoring could be effectively achieved, via a smartphone’s Wound Check app, by having patients upload photos and answer a few brief questions to gather information not easily captured through images.

“Patients cannot identify [infections] and frequently ignore or fail to recognize the early signs of cellulitis or other wound complications,” noted the study authors. “This drawback leads to the common and frustrating scenario where patients present to a routine, scheduled clinic appointment with an advanced wound complication that requires readmission, with or without reoperation. However, the complication may have been amenable to outpatient management if detected earlier,” they say.

WiSOR researchers enrolled 40 vascular surgery patients in the study. There was an overall data submission rate of 90.2 percent among study’s participants, and uploaded photo submissions were reviewed within an average of 9.7 hours. The researchers say that during the study, seven wound complications were detected and one false negative was found.

App Allows Patients to Actively Participate in Their Care

“We set out to come up with a protocol where patients could become active participants in their care and allow us to be in closer communication and monitor their wounds after they leave the hospital,” said the study’s lead author and general surgery resident Rebecca L. Gunter, M.D. “This approach allows us to intervene at an earlier time rather than waiting for patients to come back in after the problem has already developed past the point of being able to manage it on an outpatient basis,” she said.

The researchers found patients to be enthusiastic about the app’s ease of use and the reassurance they felt having their wounds regularly monitored. The nurse practitioners responsible for reviewing the submitted images confirmed the value of the photos and patient satisfaction, although they added that it was difficult to find time to review the submitted photo images on top of their very heavy clinical workload. Study authors note that the success and sustainability of a post-discharge wound-monitoring protocol requires a dedicated transitional care program and not simply adding a task to the current staff workload.

The study’s authors say that the protocol also has a cost-savings component, in addition to the patient safety and satisfaction aspects. They that SSIs are the most expensive hospital-acquired infection, costing an average of nearly $30,000 per wound-related readmission and an estimated $3-10 billion annually.

“If you could imagine saving the cost from the number of patients whose readmission you were able to prevent that result could provide significant savings to the health system,” says Dr. Gunter. Although capturing specific numbers related to cost-savings was not part of this study, Gunter noted it is an important area of focus for future studies.

Need to Understand Smartphones Technology

The study’s researchers also recognized a limitation to telemedicine protocols that calls for the use of smartphones and not every patient has the necessary technology or knowledge to upload images on their own. This issue was addressed by the WiSOR research team having participants undergo tailored training to learn to use the WoundCheck app. They provided each patient with an iPhone 5S and an accompanying visual reference guide to further assist in using the phone and app.

Gunter said they were very successful in giving patients knowledge and access to technology so they could participate in the study. She said this is a model easily adaptable to other medical centers, whether through providing participants with a phone, having a rotating supply of phones at the hospitals for patients to borrow, or relying on a patient’s personal device.

“We have demonstrated that a population of complex and high-risk patients, many of whom are older adults and novice smartphone users, can complete this protocol with high fidelity and satisfaction,” the researchers concluded.

This study was presented at the 13th Annual Academic Surgical Congress, Las Vegas, Nevada, February 2017.

 

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