Image-based digital post-discharge surveillance in England: measuring patient enrolment, engagement, clinician response times, surgical site infection, and carbon footprint

Background: Surgical site infections (SSIs) can have a significant impact on patients, their families and healthcare providers. With shortening inpatient periods, the post-discharge element of surveillance is becoming increasingly important. Proactive surveillance, including digital wound images using patient smartphones, may be an efficient alternative to traditional methods for collecting post-discharge surveillance (PDS).

Aim: To determine success in patient enrolment and engagement including reasons for non-response, the time for clinicians to respond to patients, SSI rates, and carbon emissions when conducting PDS using patient smartphones.

Methods: An evaluation was undertaken for a one-month period (June 2022) in two adult cardiac surgery services which routinely used patient smartphones for PDS, using the secure Islacare (Isla) system.

Findings: The initial patient response rate for Isla was 87.3%, and the majority of patients (73%) remained engaged throughout the 30-day period. There was no significant difference in age, gender, operation type or distance to hospital between Isla responders or non-responders, or if the hospital provided a photo at discharge or not. Patients using Isla had a shorter post-discharge stay (P = 0.03), although this was not attributed to the platform. Patients not owning a smartphone and a technical issue were the main barriers to participation. Overall, nine SSIs were recorded, eight through the Isla surveillance and one through a hospital transfer readmission. The carbon emission associated with the SSI ranged from 5 to 2615 kg CO2e.

Conclusion: In a real-world setting, using patient smartphones is an effective method to collect PDS, including wound images.