Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution

Abstract

Background: Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring "app" as a novel solution to address this problem.

Methods: Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center.

Results: From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges.

Conclusions: Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.

Figure 1. Barriers and facilitators to coping with wound complications.

Ten sub-themes identified from patient interviews related to coping with post-discharge wound complications, organized into 3 major themes. The color distribution of each bar represents the number of participants who considered each sub-theme to be a barrier (red) or a facilitator (green). Grey indicates that the participant did not mention the sub-theme.

Figure 2. Comfort with mHealth application.

Participants' comfort with 4 key elements of a wound-tracking mHealth application. Based on 4 survey questions, participants were either “Very comfortable” (dark green), “Somewhat comfortable” (light green), “Neither comfortable nor uncomfortable (grey), or “Somewhat uncomfortable” (light red). No participants selected “Very uncomfortable”.