A new tool from the ACS to study wound healing

[surgblumm]

 

Postoperative Wound Monitoring App Can Reduce Readmissions and Improve Patient Care

 

 

Patients gave universally positive feedback about the app’s ease of use and the ability to have wounds monitored

CHICAGO (January 19, 2018): 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.

 

WoundCheck is a HIPAA-compliant, user-tested iOS app that enables patients to transmit daily surgical wound images from their home to a clinician. Image courtesy of the Journal of the American College of Surgeons.

SSIs are the most common hospital-acquired infection and the leading cause of hospital readmission following an operation.^1,2,3 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.

“Patients cannot identify [infections] and frequently ignore or fail to recognize the early signs of cellulitis or other wound complications,” study authors wrote. “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.”

Forty vascular surgery patients were enrolled in the study. There was an overall data submission rate of 90.2 percent 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.

“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 lead study author and general surgery resident Rebecca L. Gunter, MD. . “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.”

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.

“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,” Dr. Gunter said. Although capturing specific numbers related to cost-savings was not part of this study, Dr. Gunter said it is an important area of focus for future studies.

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. Dr. 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.

Study coauthors from the University of Wisconsin, Madison, include Sara Fernandes-Taylor, PhD, Shahrose Rahman, BS, Lola Awoyinka, MPH, Kyla M. Bennett, MD, Sharon M. Weber, MD, FACS, Caprice C. Greenberg, MD, MPH, FACS, and K. Craig Kent, MD, FACS.

“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

Support for this study came from the Agency for Healthcare Research and Quality: AHRQ R21 HS023395. Dr. Gunter is supported by the National Institutes of Health: NIH T32 HL110853. This study was presented at the 13th Annual Academic Surgical Congress, Las Vegas, Nev., February 2017.

Citation: Feasibility of an Image-Based Mobile Health Protocol for Postoperative Wound Monitoring. Journal of the American College of Surgeons. Available at: http://www.journalacs.org/article/S1072-7515(17)32152-X/abstract. 
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1. Wiseman JT, Guzman AM, Fernandes-Taylor S, et al. General and vascular surgery readmissions: a systematic review. J Am Coll Surg 2014;219:552-569.e2.
2. Weber DJ, Sickbert-Bennett EE, Brown V, et al. Completeness of surveillance data reported by the National Healthcare Safety Network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:94-96.
3. Lewis SS, Moehring RW, Chen LF, et al. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2013;34:1229-1230.

Chapter

 

Robert M. Blumm, MA, PA, PA-C Emeritus, DFAAPA

 

The year 2017 was an amazing chapter in our lives with many changes in leadership, politics, healthcare, the advancement of both the NP and PA professions, tremendously increased knowledge in medical education, the loss of at least twenty-five international personalities and, for a number of us, a year of unprecedented medical litigations due to medical errors, the traps of an EMR, informed consents and failure to diagnose. We have gained much in the ability to enter new fields of interest and to become pioneers in specialties, but all of this has a cost. We always will pay a price to gain a prize. 

We are now writing the first few pages of a new chapter with the hopes of improving our personal skills, our professional achievements, our outcomes with our patients and our overall success in life and in the marketplace. “The new year stands before us, like a chapter in a book, waiting to be written. We can help write that story by setting goals.” Melody Beattie

In order to set goals, it is essential to know the facts and change the outcomes or the injury created by a faulty outcome. CM&F insures 12,000 NPs and PAs and serves them with diligence, respect, and instant access. With OPA becoming the buzz word for PAs in this new year, it is my hope that PAs with an eye toward future independent practice will become aware of the absolute need to have a personal liability insurance policy as offered by CM&F as the endorsed group for the AAPA. This could have an extremely favorable impact on premiums for PAs. 

There are so many positive aspects of independent practice for NPs, but payouts for malpractice claims filed against NPs are on the rise, according to a new report. The average payout was $240,471 according to studies from CNA Insurance which covers NP malpractice insurance. The highest area of claims is neonatal, which at only 1% of the claims was $630,411. Obstetrics, another high-risk area, had indemnities that averaged $417,500. The lowest of the three was emergency medicine with indemnities averaging $277,812. Though those three specialties accounted for the costliest claims, the vast majority of closed claims were related to four other specialties: adult primary care, family practice, behavioral health, and gerontology. It is surprising, as well as a hidden trap, that most of these were related to a failure to order a medical test or obtain an address that test result.* As I mentioned earlier, knowledge of the facts can dramatically change the outcome; the meticulous attention of the provider is essential.

So my fellow colleagues, how will we write the 2018 chapter of our history?  We can all hope for a greater future with less misadventure, fewer litigations, and healthier patients. But we must engage with the conscious reminder that we are caregivers and we are, therefore, vulnerable. Why carry that vulnerability on our own shoulders when the fear, anxiety, and burden can be shouldered by personal liability insurance? How empowering is the knowledge that we are protected from potential errors by specialists who are experienced fighters in this field of litigation? What do you believe? What price are you willing to pay to obtain security and peace? “Beliefs have the power to create and the power to destroy. Human beings have the awesome ability to take any experience of their lives and create a meaning that dis-empowers them or one that can literally save their lives.” Tony Robbins. Let us join hands together and make the latter choice.

* Source-  

CNA and Nurses Services Organization (2017, October).  CNA and NSO Nurse Practitioner Claim Report (4^th Edition): A Guide to Identifying and Addressing Professional Liability Exposures, page 12.  Retrieved from https://www.nso.com/Learning/Artifacts/Claim-Reports/Nurse-Practitioner-Claim-Report-4th-Edition-A-Guide-to-Identifying-and-Addressing-Professional-Liability-Exposures.

 

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Robert M. Blumm, MA, PA,PA-C Emeritus, DFAAPA

Surgical PA, National Conference Speaker, Author, Suture Workshop Director, Former AAPA Liaison to American College of Surgeons, Past President four National Associations, Editorial Board Clinician1.com, Advisory Board POCN., AFPPANP Treasurer                                                                                            

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