Can a smartphone-delivered tool facilitate the assessment of surgical site infection and result in earlier treatment? Tracking wound infection with smartphone technology (TWIST): protocol for a randomised controlled trial in emergency surgery patients

Abstract

IntroductionNational data suggest that surgical site infection (SSI) complicates 2%–10% of general surgery cases, although the patient-reported incidence is much higher. SSIs cause significant patient morbidity and represent a significant burden on acute healthcare services, in a cohort predominantly suitable for outpatient management. Over three-quarters of UK adults now own smartphones, which could be harnessed to improve access to care. We aim to investigate if a smartphone-delivered wound assessment tool results in earlier treatment.Methods and analysisThis is a randomised controlled trial aiming to recruit 500 patients across National Health Service (NHS) hospitals. All emergency abdominal surgery patients over the age of 16 who own smartphones will be considered eligible, with the exclusion of those with significant visual impairment. Participants will be randomised in a 1:1 ratio between standard postoperative care and the intervention – use of the smartphone tool in addition to standard postoperative care. The main outcome measure will be time-to-diagnosis of SSI with secondary outcome measures considering use of emergency department and general practitioner services and patient experience. Follow-up will be conducted by clinicians blinded to group allocation. Analysis of time-to-diagnosis will be by comparison of means using an independent two sample t-test.Ethics and disseminationThis is the first randomised controlled trial on the use of a smartphone-delivered wound assessment tool to facilitate the assessment of SSI and the impact on time-to-diagnosis. The intervention is being used in addition to standard postoperative care. The study design and protocol were reviewed and approved by Southeast Scotland Research and Ethics Committee (REC Ref: 16/SS/0072 24/05/2016). Study findings will be presented at academic conferences, published in peer-reviewed journals and are expected in 2020. A written lay summary will be available to study participants on request.Trial registration number NCT02704897; Pre-results.

Digital tools for post‐discharge surveillance of surgical site infection

“…The identified digital tools were tested among patients of different surgical specialities, and the main functionalities were the previously prepared questionnaire, the attachment of a wound image, the integrated Web system, and the evaluation of data by the health team, with post-discharge SSI surveillance period between 14 and 30 days after surgery. Thus, the digital tools applied synchronous, asynchronous or blended telemedicine, such as a health professional evaluating the responses and established contact by phone (Gunter et al, 2018) and face-to-face evaluation (McLean et al, 2019), and even completely asynchronous assessment tools, achieving high patient satisfaction Gunter et al, 2016Gunter et al, , 2018Scheper et al, 2019).…”

“…All 10 evaluated tools featured questionnaires that addressed clinical and surgical aspects, signs and symptoms related to the surgical wound, requiring yes or no responses, the attachment of a wound image and the use of a web platform for data (Alwis, 2022;Castillo et al, 2017;Fernandes-Taylor et al, 2017;Gunter et al, 2016Gunter et al, , 2018McLean et al, 2019McLean et al, , 2021Mousa et al, 2017;Ohr et al, 2021;Sanger et al, 2016;Scheper et al, 2019;Zhang et al, 2019). Other features offered were the use of devices to check the patient's vital signs, automatically sending the results via Bluetooth to the device used by the patient (Mousa et al, 2017); a satisfaction survey throughout the follow-up (Mousa et al, 2017); risk classification of patients after data analysis by a clinical researcher (Mousa et al, 2017); or a daily risk score based on questionnaires which issued high-risk alerts (Scheper et al, 2019).…”

Reliability and feasibility of registered nurses conducting web‐based surgical site infection surveillance in the community: A prospective cohort study

“…The literature review conducted for this research preceded the use of newer strategies, including telehealth, mobile health (mHealth), or smartphones to provide real‐time patient‐provider image sharing and communication to conduct SSI surveillance in the community. 20,21 …”

“…The literature review conducted for this research preceded the use of newer strategies, including telehealth, mobile health (mHealth), or smartphones to provide realtime patient-provider image sharing and communication to conduct SSI surveillance in the community.. 20,21 The current updated version of the how2trak SSI surveillance application allows for both synchronous and asynchronous patient-provider connections. After each patient photographs his/her incision the resulting assessment report is shared with the physician and team who may then either (a) review and advise the patient through secure messaging or (b) schedule a virtual visit if needed.…”

Smartphone and Surgery, Reality or Gadget?

“…Monitoring can be done through sharing images of the surgical site and remote video conferencing. [62,63]…”