Posted: January 15th, 2024

Evaluating a Telehealth Program for Post-Surgical Wound Monitoring

Evaluating a Telehealth Program for Post-Surgical Wound Monitoring

Telehealth is the use of information and communication technologies to deliver health care services remotely. Telehealth can be applied to various aspects of health care, such as diagnosis, treatment, education, and prevention. One of the areas where telehealth has shown potential benefits is wound care, especially for patients who have undergone surgery and need post-discharge follow-up.

Post-surgical wound monitoring is essential to prevent complications such as surgical site infections (SSIs), which can lead to increased morbidity, mortality, and health care costs. SSIs are among the most common health care-associated infections, affecting about 2-5% of patients undergoing inpatient surgery [1]. Many SSIs develop during the first 30 days after discharge, when patients may not have adequate access to wound care services or may not recognize the early signs of infection [2].

Telehealth can offer a solution to this challenge by enabling remote wound assessment and management through various modalities, such as mobile applications, web-based platforms, video consultations, or telephonic support. Telehealth can provide patients with timely feedback, education, and guidance on how to care for their wounds at home, while allowing health care providers to monitor the wound healing process and intervene promptly if needed [3].

However, telehealth is not a one-size-fits-all approach and requires careful evaluation to determine its feasibility, acceptability, effectiveness, and cost-effectiveness in different settings and populations. Therefore, this paper aims to evaluate a telehealth program for post-surgical wound monitoring in abdominal surgeries, which are among the most common surgical procedures and have a high risk of SSIs [4].

The paper is organized as follows:

– Introduction: This section provides the background and rationale for the study, as well as the research question and objectives.
– Methods: This section describes the design, setting, participants, intervention, outcomes, data collection, analysis, and ethical considerations of the study.
– Results: This section reports the findings of the data analysis, including descriptive statistics, inferential statistics, and qualitative themes.
– Discussion: This section interprets the results in relation to the existing literature, discusses the implications for practice and policy, and identifies the limitations and strengths of the study.
– Conclusion: This section summarizes the main points of the paper and provides recommendations for future research.

Introduction

Abdominal surgery is a broad term that encompasses various types of surgical procedures involving the abdominal cavity or its organs, such as appendectomy, cholecystectomy, colectomy, gastrectomy, hernia repair, or hysterectomy. Abdominal surgery is performed for various indications, such as inflammation, infection, obstruction, malignancy, or trauma [4].

Abdominal surgery is associated with a high risk of SSIs due to several factors, such as the presence of microorganisms in the gastrointestinal tract, the complexity and duration of the surgery,
the degree of tissue damage and contamination during the operation,
the use of foreign materials such as sutures or meshes,
and the patient’s comorbidities and immune status [4].

SSIs can have serious consequences for patients’ health and quality of life,
such as pain,
delayed wound healing,
increased scarring,
reoperation,
sepsis,
organ dysfunction,
or death [1].
SSIs can also have significant economic impacts on the health care system,
such as increased length of hospital stay,
readmission,
antibiotic use,
additional procedures,
or litigation [1].

Therefore,
preventing and managing SSIs is a priority in post-surgical wound care.
However,
many patients face barriers to accessing adequate wound care services after discharge from hospital,
such as lack of transportation,
financial constraints,
geographical distance,
or limited availability of qualified providers [2].
Moreover,
many patients may not be aware of the signs and symptoms of SSIs or may not adhere to the recommended wound care practices at home [2].

Telehealth can address these challenges by providing remote wound monitoring and support through various technologies,
such as smartphones,
tablets,
computers,
or cameras [3].
Telehealth can enable patients to send wound images or videos,
answer standardized questions about their wound status and symptoms,
receive feedback and education from health care providers,
and communicate with them via text messages,
phone calls,
or video calls [3].
Telehealth can also allow health care providers to access patients’ wound data in real time,
assess their risk of infection or complications using algorithms or models,
and intervene accordingly by adjusting their treatment plan,
prescribing medications,
or referring them to in-person care if needed [3].

Several studies have evaluated telehealth interventions for post-surgical wound monitoring in different settings and populations.
For example,

– Baniasadi et al. [2] developed a mobile health application for wound telemonitoring in abdominal surgery patients in Iran. The application allowed patients to send wound images and self-reported symptoms via systematic tele-visits based on predetermined indexes. The application also generated alerts for health care providers based on a risk-based model derived from the incidence, frequency, and severity of SSI-related symptoms. The pilot study showed that the application was feasible and acceptable to patients and providers, and that it improved patients’ satisfaction and adherence to wound care.
– Oropallo et al. [5] implemented a telehealth program for wound care in vascular surgery patients in the US. The program consisted of a web-based platform that enabled patients to upload wound images and answer questions about their wound status and symptoms. The platform also provided patients with education and feedback on their wound care. The program was integrated with an electronic health record system that allowed health care providers to access patients’ wound data and communicate with them via secure messaging or video calls. The retrospective study showed that the program reduced the rate of SSIs, hospital readmissions, and emergency department visits, and increased the rate of wound healing.
– Sanger et al. [6] evaluated a telehealth service for wound care in colorectal surgery patients in the UK. The service involved a smartphone application that allowed patients to send wound images and self-reported symptoms to a nurse-led team. The team reviewed the wound data and provided patients with advice and support via phone calls or text messages. The team also referred patients to in-person care if needed. The randomized controlled trial showed that the service was safe and effective in reducing the incidence of SSIs, improving patients’ quality of life, and saving costs.

These studies suggest that telehealth can be a viable option for post-surgical wound monitoring,
especially in the context of the COVID-19 pandemic,
when more patients may prefer or need telecare services [5].
However,
telehealth is not without challenges or limitations,
such as technical issues,
data security,
legal liability,
reimbursement policies,
or patient and provider acceptance [3].
Moreover,
telehealth interventions may vary in their design,
implementation,
and evaluation,
depending on the type of surgery,
the type of technology,
the type of provider,
the type of outcome,
and the type of analysis [3].

Therefore,
there is a need for more rigorous and comprehensive evaluation of telehealth programs for post-surgical wound monitoring in different settings and populations.
The aim of this paper is to evaluate a telehealth program for post-surgical wound monitoring in abdominal surgery patients in Kenya.

The research question is:

– How feasible, acceptable, effective, and cost-effective is a telehealth program for post-surgical wound monitoring in abdominal surgery patients in Kenya?

The objectives are:

– To assess the feasibility of implementing the telehealth program in terms of recruitment, retention, adherence, and technical performance.
– To assess the acceptability of the telehealth program from the perspectives of patients and providers using qualitative methods.
– To assess the effectiveness of the telehealth program in terms of reducing the incidence of SSIs, improving wound healing, enhancing patient satisfaction, and increasing provider efficiency using quantitative methods.
– To assess the cost-effectiveness of the telehealth program in terms of health care utilization, resource use, and cost savings using economic analysis.

Methods

Design

The study will use a mixed-methods approach combining quantitative and qualitative methods. The study will consist of two phases: a pilot phase and a main phase.

The pilot phase will involve a feasibility study to test the telehealth program in a small sample of abdominal surgery patients (n=20) and providers (n=10) over a period of 30 days. The pilot phase will use both quantitative and qualitative methods to collect data on feasibility, acceptability, usability, satisfaction, and preliminary outcomes.

The main phase will involve a randomized controlled trial (RCT) to compare the telehealth program with usual care in a larger sample of abdominal surgery patients (n=200) and providers (n=50) over a period of 30 days. The main phase will use quantitative methods to collect data on effectiveness, efficiency, and cost-effectiveness.

Setting

The study will be conducted at Kenyatta National Hospital (KNH), which is the largest public hospital in Kenya and serves as a referral center for various surgical specialties. KNH has an average of 3000 abdominal surgeries per year, with an estimated SSI rate of 10% [7]. KNH has a dedicated wound care clinic that provides post-discharge follow-up services for surgical patients. However, the clinic faces challenges such as limited staff, equipment, space, and time, as well as high patient demand [7]. Therefore, KNH is an ideal setting to implement and evaluate a telehealth program for post-surgical wound monitoring.

Participants

The study will include two groups of participants: abdominal surgery patients and wound care providers.

Abdominal surgery patients will be eligible to participate if they meet the following criteria:

– Aged 18 years or older
– Undergone elective or emergency abdominal surgery at KNH
– Discharged from hospital within 7 days after surgery
– Have access to a smartphone

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