Can a smartphone-delivered tool facilitate the assessment of surgical site infection and result in earlier treatment? Tracking wound infection with smartphone technology (TWIST): protocol for a randomised controlled trial in emergency surgery patients
by James Glasbey, NIHR Doctoral Research Fellow in Surgery
This paper reports the protocol for an elegant, pragmatic, individually-randomised controlled trial testing a novel mHealth intervention within the surgical wound infection pathway, versus standard care.
Questions with the author:
WReN had the opportunity to talk to the corresponding author for the TWIST trial protocol, Dr Kenneth McLean, a Clinical Academic at Edinburgh University:
WReN: Hi Kenny, thanks for talking to WReN about your upcoming trial. How do you think TWIST results may impact on routine practice?
Kenny: We hypothese the TWIST smartphone tool will reduce the time-to-diagnosis of SSI, and so potential harm experienced by patients. Many barriers exist to implementing telehealth interventions in routine practice, however we hope TWIST will be able to provide both a clinical and health economic argument for postoperative care and beyond.
WReN: Why did you choose time to diagnosis as your primary outcome measure?
Kenny: Patients symptomatic of SSI should be assessed expediently and treated appropriately. Time to diagnosis was chosen as a pragmatic endpoint (rather than SSI rate or time from symptom onset) given this is largely reflective of patients’ access to care and can be more accurately recorded across healthcare settings.
WReN: With the advent of high-quality mobile phone imaging and videography, do you see a place for a combined triage alongside the TWIST text messaging protocol?
In the TWIST trial, patients complete both patient-reported outcomes on SSI and submit? wound images via the smartphone tool, which then receive separate risk-classifications for SSI. It will be interesting to compare these classifications and explore the added diagnostic utility of both methods of assessment in SSI triage.
WReN: Do you think patients will find follow-up using mobile phones acceptable? How are you planning to monitor this?
Patients increasingly recognise the value of telemedicine – healthcare professionals are often the more reluctant group to engage. However, we must ensure these interventions meet the shared needs of both patients and clinicians. Patients are asked to provide their postoperative care experience in the TWIST trial to inform future development of the tool and other future telemedicine interventions.
WReN: How did you create your wound assessment tool and algorithm?
At the time of design, most patient-reported outcomes for SSI in the literature were based on the CDC diagnostic criteria and ASEPSIS model, and so these were incorporated into the tool. Both the wound assessment tool and algorithm were developed for the purposes of SSI risk classification (within the hospital setting), rather than for diagnosis, allowing triage to either community or hospital care if the senior clinician felt appropriate.