Brian Do, Ross Lordon, Mark Stewart, Justin McReynolds, Julie Cooper, Kristen Helps, Kailey Sparks, JoAnne Whitney, RN, PhD, William Lober, MD, MS, Heather L Evans, MD, MS. University of Washington
Objective of the technology or device: Surgical site infections (SSI) are a major source of preventable morbidity, mortality, and healthcare expenditures. The top contributor to overall costs due to healthcare associated infections, SSIs affect 500,000 post-surgical patients in the United States annually and cost up to $20,000 per infection. As hospital stays have become shorter, most SSIs now occur after discharge, but before the first clinic follow-up visit, leaving the onus on patients to identify wound problems, and to initiate contact with their providers. While post-discharge SSI is associated with up to a six-fold increased risk of hospital readmission and three-fold risk of death, there are no established standardized or reliable methods for post-discharge SSI surveillance.
Description of the technology and method of its use or application: Informed by iterative user-centered design, we developed mPOWEr: a mobile health (mHealth) application (app) that leverages the ease of communication and image sharing afforded by smartphones and other mobile devices to address the current gap in care and wound surveillance after hospital discharge following surgery. mPOWEr’s patient-facing app enables patients to monitor their surgical wounds for signs and symptoms of infection using a structured questionnaire and photo capture. Patient-reported data are encrypted and transmitted to a secure database on a HIPAA-compliant server. The provider-facing web dashboard allows clinicians to serially track single or multiple patients, and visualize changes in patient-reported symptoms and wound images.
Preliminary results: mPOWEr has been implemented as a quality improvement pilot project in the UW Medicine Center for Reconstructive Surgery. In the initial 6 weeks of use, 14 patients have recorded symptoms and/or saved wound photographs using the mPOWEr app, ranging from 1-14 wound diary sessions, from post-operative day 1 to day 20. Patient users were characterized as generally comfortable with technology, and most had brought their phone to clinic on the day they registered for the app. Feedback from both provider and patient users informed the development of a series of instructional videos and support materials.
Conclusions / Future Directions: By engaging patients in guided self-monitoring of their post-operative wounds, this novel mHealth platform can improve patient satisfaction. By earlier detection of potential wound problems, SSIs can be managed before they escalate to the point of unplanned evaluation in the emergency room, and/or hospital readmission. Likewise, through serial symptom and photo monitoring, patients meeting expected post-discharge milestones may avoid unnecessary follow up visits. This may not only improve patient satisfaction, but also frees up the provider to see new patients with pressing clinical problems, improving patient flow and efficiency of care delivery. Further, population-level assessments of mPOWEr 30-day outcomes and patient satisfaction data may be tracked for institutional quality improvement and reporting. mPOWEr will transform post-discharge standard of care by delivering personalized patient-centered care that incorporates monitoring risk in real-time after surgery, a time when in-person evaluations are inconvenient for patients and inefficient for providers and health systems.