Can Automated Prompts Reduce Surgical Site Infections?

More than 90% of patients surveyed followed preoperative protocols to prevent surgical site infections. Researchers believe this inexpensive strategy will reduce SSIs.

A common sense-based by medical students at Washington University School of Medicine in St. Louis provides a good example of the benefits of patient engagement.

The research, led by second-year students Michelle Keyin Lu and Christopher Chermside-Scabbo, looked at patient engagement as a tool in reducing surgical site infection. It is the third most common healthcare-associated infection, adversely affecting more than 500,000 patients each year.

Lu, Chermside-Scabbo, and their student-colleagues measured the effect of an automated text and voice messaging system to improved communication with orthopedic surgery patients.

The daily prompts reminded the patients a week before their operations to use antibiotic skin ointments and body wash, and in the two weeks after surgery the daily prompts coached patients on the warning signs of infections, such as pain, redness, odor, and discharge.

Lu and Chermside-Scabbo presented their findings this week at the 2016 American College of Surgeons National Surgical Quality Improvement Program Conference in San Diego. The automated prompt system was developed by Epharmix, a healthcare information technology startup company founded by students from the Washington University School of Medicine. 

Chermside-Scabbo and Lu are independent researchers at Epharmix, and neither holds a position in the company.  

NSQIP encourages the use of preoperative antibiotics to decrease SSIs but only half of patients comply with the protocols. Relatively speaking, orthopedic procedures have a low SSI rate, ranging from 0.7 to 2.1 infections for every 100 cases.

Orthopedic surgery patients with SSIs, however, also have a two times higher rate of rehospitalization and a 300% increase in treatment costs.

High Rate of Patient Engagement

The automated text and voice prompts were tested on 430 orthopedic surgery patients at Washington University Barnes-Jewish Hospital. Of those patients, 96% responded to the pre-operative prompts and 90% responded to the postoperative prompts.

"We were surprised that it was this high," Chermside-Scabbo says. "We suspect that perhaps the nature of the surgery, being a big occasion that the patients take pretty seriously, could be a factor in that high response rate."

A post-event survey found that most patients believed the prompts improved communication with their surgeons; the median score was 8 on a scale of 1 to 9. Patients gave their overall care a 9.

And most patients said the prompts were easy to use and gave them confidence that they were doing the right things to help their recovery, made them feel cared about, and connected them to the patient care service.

"This isn't an application-based system," Chermside-Scabbo says. "A lot of healthcare systems are using their own proprietary apps that require the patients to download and log in. This system just needs a phone number. If it is an elderly patient and they don't have a phone, we can text; there is [also] a voice system they can use."

Effect on Infection Rates?

Of course, the big question is whether or not these audio and text prompts reduced SSI rates. Unfortunately, Chermside-Scabbo says the test group was too small to answer that question. They hope to have that question answered in their next series of studies.

"When we tried to power the study to show how many patients we'd need to really show a difference the number was in the thousands," he says. "That is why we chose to focus this study on the usability to make sure our message frequency was something the patients liked and that the response rates were adequate."

"Now we plan to move to other procedures that have higher complication rates historically, such as hip fractures, and specialties like colorectal surgery," he says.

"Instead of having SSI rates in the 3% to 5% ballpark, colorectal and other procedures have complication rates as high as 15% to 25%. In the coming months we intend to test that to show if our system can demonstrate a reduction in complications."