A new smartphone app called WoundCare is successfully enabling patients to remotely send images of their surgical wounds for monitoring by nurses. The app was developed by researches from the Wisconsin Institute of Surgical Outcomes Research (WiSOR), Department of Surgery, University of Wisconsin, Madison, with the goal of earlier detection of surgical site infections (SSIs) and prevention of hospital readmissions. The study results appear as an “article in press” on the website of the Journal of the American College of Surgeons ahead of print.
SSIs are the most common hospital-acquired infection and the leading cause of hospital readmission following an operation. Due to the prevalence off SSIs, the WiSOR research team decided to see if postoperative wound monitoring could be effectively achieved by having patients upload photos through the WoundCare app and answer a few brief questions to gather information not easily captured through images.
Forty vascular surgery patients were enrolled in the study. There was an overall data submission rate of 90.2% among participants, and submissions were reviewed within an average of 9.7 hours. During the study, seven wound complications were detected and one false negative was found.
Patients were 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 attested to the value of the photos and patient satisfaction, although they also noted it was difficult to find time to review the submitted images on top of an already 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.
This protocol also has a cost-savings component, in addition to the patient safety and satisfaction aspects. Study authors note 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.
A limitation to telemedicine protocols that call for the use of smartphones is that not every patient has the necessary technology or knowledge to upload images on their own. The WiSOR research team addressed this issue by 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.