A Mobile App for Wound and Symptom Surveillance After Colorectal Surgery: Protocol for a Feasibility Randomized Controlled Trial.

BACKGROUND: Surgical site infections (SSIs) are the most common nosocomial infection and occur in 16.3% of patients undergoing colorectal surgery at our institution (The Ottawa Hospital), the majority of which are identified after discharge from hospital. Patients who suspect having an SSI generally present to the emergency department or surgery clinic. Both options for in-person interaction are costly to the health care system and patients. A mobile app, how2trak, has proven to be beneficial for patients with complex wounds at our institution by facilitating at-home monitoring and virtual consultations. OBJECTIVE: This study aims to assess the feasibility of a randomized controlled trial to assess if how2trak can improve patients' experience and increase detection of SSIs after colorectal surgery while reducing patients' risk of COVID-19 exposure. METHODS: In this single-center prospective feasibility trial, eligible patients undergoing colorectal surgery will be randomized to either standard care or how2trak postoperative monitoring of their incision, symptoms, and ostomy function. Patient self-assessments will be monitored by a nurse specialized in wound and ostomy care who will follow-up with patients with a suspected SSI. The primary outcome is feasibility as measured by enrollment, randomization, app usability, data extraction, and resource capacity. RESULTS: This study was approved by our institution's ethics board on February 26, 2021, and received support from The Ottawa Hospital Innovation and Care Funding on November 12, 2021. Recruitment started June 3, 2021, and 29 were patients enrolled as of September 2021. We expect to publish results in spring 2022. CONCLUSIONS: This study will determine the feasibility of using a mobile app to monitor patients' wounds and detect SSIs after colorectal surgery. If feasible, we plan to assess if this mobile app facilitates SSI detection, enhances patient experience, and optimizes their care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04869774; https://clinicaltrials.gov/ct2/show/NCT04869774. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26717.

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

Surgical site infections increase health care costs, morbidity, and mortality in 2% to 5% of surgical patients. Standardised post-surgical surveillance is rare in community settings, causing under-reporting and under-serving of the documented 60% of surgical site infections occurring following hospital discharge. This study evaluated feasibility and concordance (inter-rater reliability) of paired registered nurses using a web-based surveillance tool (how2trakSSI, based on validated guidelines) to detect surgical site infections for up to 30 days after surgery in a cohort of 101 patients referred to Calea Home Care Clinics in Toronto, Canada, March 2015 to July 2016. After paired registered nurse assessors used the tool-less than 10 minutes apart to measure concordance 5 to 7 days postoperatively, they provided feedback on its usefulness at two teleconference discussion groups September 6 to 7, 2016. Overall concordance between assessors was 0.822, remaining consistently above 0.65 across assessor education level and experience, patient age and weight, and wound area. Assessors documented 39.6% surgical site infection prevalence 5 to 7 days after surgery, confirming clinical need, relevance, reliability, and feasibility of using this web-based tool to standardise community surgical site infection surveillance, noting that it was user-friendly, more efficient to use than traditional paper-based tools and useful as a registry for tracking progress.

Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology.

BACKGROUND: Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). PRIMARY OBJECTIVE: Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. SECONDARY OBJECTIVE: Estimate the rate of SSIs and associated predisposing factors. METHODS: Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. RESULTS: A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. CONCLUSIONS: Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.

Adverse events associated with hospitalization or detected through the RAI-HC assessment among Canadian home care clients.

BACKGROUND: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). METHOD: A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. RESULTS: The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. CONCLUSION: The incidence of AEs from all sources of data ranged from 4% to 9%. More resources are needed to target strategies for addressing safety risks in HC in a broader context. Tools such as the RAI-HC and its Clinical Assessment Protocols, already available in Canada, could be very useful in the assessment and management of HC clients who are at safety risk.

Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study.

BACKGROUND: Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario. METHODS: A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences. RESULTS: The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death. CONCLUSIONS: Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.

Closing the Gap Between Evidence and Action: How Outcome Measurement Informs the Implementation of Evidence-based Wound Care Practice in Home Care.

UNLABELLED:  Measured outcomes can help assure successful implementation of evidence-based wound care programs by informing patients, professionals, and payors that a health care system is both efficient and effective. OBJECTIVE: Illustrate how clinical and economic outcome measurement was important to ensure sustainability of standardized evidence-based wound care programs implemented in Canadian community care. METHODS: Client assessments, dressing change frequency, wound healing, and economic outcomes were measured on 16,079 Canadian home care clients, including 8089 with a total of 11,160 chronic or acute wounds during standardized evidence-based protocol implementation that involved education, knowledge transfer, strategic planning, management accountability/receptivity, communication, and either prospective client assessment-based data or retrospective chart audit data to measure outcomes. RESULTS: Results from 3 regions illustrate how evidence-based protocol use decreased length of service, dressing change frequency, wound care costs, and wound closure time. Client and staff empowerment and management involvement were among key factors for success. CONCLUSION: Objectively measuring and reporting outcomes provided a concrete context for increasing organizational efforts to improve wound care practices and provided a solid foundation for sustained evidence-based protocol usage as it allowed agencies to track improvement in health and economic outcomes.

Managing wound care outcomes.

Chronic wounds increase home care costs, stressing an already overburdened system. To improve costs and wound outcomes of home care in Nova Scotia, dedicated home care professionals collaborated with the Nova Scotia Department of Health Clinical Issues Committee in a four-phase endeavor. In Phase I, a descriptive, retrospective chart review (1995-1999) was conducted using an Outcomes Management Model research framework to assess existing wound prevalence, costs, and outcomes of care in the Nova Scotia Home Care setting. In Phase II, using literature-based best available evidence, the Nova Scotia Standardized Prevention and Treatment Protocol was developed. In Phase III, the Protocol was disseminated to 20 Nova Scotia healthcare agencies educated on its use. Wound care outcomes and costs were measured in Phase IV using a prospective, quasi-experimental, descriptive study design. The study found that before 1999, Nova Scotia Home Care wound care practices were costly and outdated, yielding sporadically recorded, often inferior, outcomes--eg, 30% of patients had pressure ulcers, 42% received daily home care visits, and of the 115 (24.6%) clients with venous leg ulcers only 16 received compression therapy. The Protocol increased awareness of the principles of moist wound healing and reduced the prevalence of chronic wounds, dressing change frequency, healing time, and costs of care. Phase IV study results (n = 50) showed an average decline in labor and materials costs of dollar 946.64 per client per month after Protocol implementation. The Nova Scotia Protocol enables home care professionals to provide quality wound care and has since been issued as policy for Home Care in Nova Scotia.