title: Feasibility of Implementing a Patient-Centered Postoperative Wound Monitoring Program Using Smartphone Images: A Pilot Protocol.
abstract: BACKGROUND
  Surgical site infections (SSI) represent a significant public health problem as the most common nosocomial infection and a leading cause of unplanned hospital readmissions among surgical patients. Many develop following hospital discharge and often go unrecognized by patients. Telemedicine offers the opportunity to leverage the mobile technology to remotely monitor wound recovery in the transitional period between hospital discharge and routine clinic follow-up. However, many existing telemedicine platforms are episodic, replacing routine follow-up, rather than equipped for continued monitoring; they include only low-risk patient populations and those who already have access to and comfort with the necessary technology; and transmit no visual information.
  
  
  OBJECTIVE
  Drawing upon the Coleman model for care transitions and the Proctor model for implementation, we propose a protocol of postoperative wound monitoring using smartphone digital images. In this study, we will establish the feasibility of such a program, both for patients and for the clinical care team.
  
  
  METHODS
  We will recruit 40 patients or patient/caregiver pairs from our inpatient vascular surgery service. Eligible patients will be English-speaking, 18 years of age or older, and have an incision at least 3 cm in length. Participants will receive a training session, during which they will learn to use the device and the wound monitoring smartphone app. Following hospital discharge, they will submit digital images of their wound and responses to a survey about their recovery for 14 days. Experienced health care providers on the vascular surgery inpatient service will review transmitted data daily and contact patients for any concerning findings.
  
  
  RESULTS
  Primary outcomes will include participant adherence to the protocol, time required for providers to review submissions, time from submission to provider review, and participant satisfaction. Secondary outcomes will include SSI detection and hospital readmission.
  
  
  CONCLUSIONS
  Health systems are increasingly dedicating efforts to transitional care improvement programs. This feasibility trial will confirm whether patients and their caregivers can learn to use a postdischarge wound monitoring smartphone app and will assess patient and provider satisfaction. This protocol will provide preliminary evidence for a shift in the delivery of postdischarge care in a patient-centered and cost-effective manner.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02735525; https://clinicaltrials.gov/ct2/show/NCT02735525 (Archived by WebCite at http://www.webcitation.org/6oIvN4Mab).
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0003-0007-0677
authors.initials: S
authors.lastname: Fernandes-Taylor
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: Rebecca L
authors.identifier: http://orcid.org/0000-0002-3279-6707
authors.initials: RL
authors.lastname: Gunter
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: Kyla M
authors.identifier: http://orcid.org/0000-0002-8582-2593
authors.initials: KM
authors.lastname: Bennett
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: Lola
authors.identifier: http://orcid.org/0000-0003-0536-0550
authors.initials: L
authors.lastname: Awoyinka
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: Shahrose
authors.identifier: http://orcid.org/0000-0003-3138-2518
authors.initials: S
authors.lastname: Rahman
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: Caprice C
authors.identifier: http://orcid.org/0000-0001-9718-2717
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, United States.
authors.forename: K Craig
authors.identifier: http://orcid.org/0000-0002-4073-6202
authors.initials: KC
authors.lastname: Kent
keywords: clinical research protocol; feasibility study; smartphone; surgical site infection; telemedicine; transitional care