Engaging Patients in Co-Design of Mobile Health Tools for Surgical Site Infection Surveillance: Implications for Research and Implementation

Digital tools for post-discharge surveillance of surgical site infection

AIMS

Conduct a scoping review on the development and use of digital tools for post-discharge surgical site infection surveillance.

DESIGN

Scoping review.

DATA SOURCES

Science Direct, PubMed, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde and Cumulative Index to Nursing and Allied Health Literature were searched from 2013 to May 2022. Six intellectual property registries were reviewed from 2013 to 2022.

REVIEW METHODS

The review followed the Joanna Briggs Institute model, and included intellectual property records (applications, prototypes and software) and scientific articles published in any language on the development and/or testing of digital tools for post-discharge surveillance of surgical site infection among surgical patients aged 18 and over.

RESULTS

One intellectual property record and 13 scientific articles were identified, covering 10 digital tools. The intellectual property record was developed and registered by a China educational institution in 2018. The majority of manuscripts were prospective cohort studies and randomized clinical trials, published between 2016 and 2022, and more than half were conducted in the United States. The population included adult patients undergoing cardiac, thoracic, vascular, abdominal, arthroplasty and caesarean surgery. The main functionalities of the digital tools were the previously prepared questionnaire, the attachment of a wound image, the integrated Web system and the evaluation of data by the health team, with post-discharge surgical site infection surveillance time between 14 and 30 days after surgery.

CONCLUSION

Digital tools show promise for the surveillance of surgical site infection, collaborating with the early detection of wound infection.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Mobile technology was favourable for detecting surgical site infections, reducing unnecessary visits to the health service, and increasing patient satisfaction.

IMPACT

Technological advances in the health area open new perspectives for post-discharge surveillance of surgical site infection. WHAT IS ALREADY KNOWN?: There is underreporting of surgical site infections due to difficulties related to traditional methods of post-discharge surveillance. The use of digital tools within surgical site infection surveillance is increasing. Benefits of using digital tools within surgical site infection surveillance have been reported. WHAT HAS THIS STUDY ADDED TO OUR KNOWLEDGE?: This scoping review is one of the first to analyse the development and use of digital tools for post-discharge surveillance of surgical site infection in different countries. The main functionalities of digital tools are: structured questionnaires; attachment of wound images; integrated web systems; and evaluation of data by professionals. The use of mobile technology is favourable for detecting surgical site infections with a reduction in costs from face-to-face consultations and increased patient satisfaction. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Healthcare providers can successfully use digital tools for surgical site infection post-discharge surveillance. Remote monitoring can reduce unnecessary patient visits to healthcare facilities. Policy makers can study how to implement digital platforms for remote patient monitoring.

REPORTING METHOD

PRISMA statement for Scoping Reviews (PRISMA-ScR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

TRIAL AND PROTOCOL REGISTRATION

The study protocol was registered in the OSF (https://doi.org/10.17605/OSF.IO/BA8D6).

Patient participation in surgical site infection prevention: perceptions of nurses, physicians and patients

OBJECTIVE

To analyze the perception of patients and health professionals regarding patients' participation in surgical site infection prevention.

METHODS

Cross-sectional study conducted in two hospitals in the city of São Paulo, with a convenience sample of 123 patients in the postoperative period of elective surgeries and 92 health professionals (physicians and nurses) acting in direct care of surgical patients.

RESULTS

Patients (78.9%) and professionals (79.4%) fully agreed with the importance of patient participation to prevent surgical site infection. The impact of patient participation on infection rates was significant for those undergoing previous surgery (p = 0.021). Patients and professionals disagreed about the best time to prepare the patient about the topic (p<0.001). The participation strategies considered most effective by patients and professionals were, respectively, oral presentation (47.2% and 75%), videos (40.7% and 58.7%) and leaflets (30.9% and 58.7%).

CONCLUSION

Patients and health professionals believe that patient participation in surgical site infection prevention is important.

Co-created Technological Solutions for Caregivers in Health Care: Systematic Review

BACKGROUND

Support interventions for caregivers can reduce their stress, possibly improving the quality of patients' care while reducing care costs. Technological solutions have been designed to cover their needs, but there are some challenges in making them truly functional for end users. Co-design approaches present important opportunities for engaging diverse populations to help ensure that technological solutions are inclusive and accessible.

OBJECTIVE

This study aimed to identify co-created technological solutions, as well as the process followed for their co-creation, in the field of health for caregivers.

METHODS

The literature review was conducted in the Medline, Web of Science, Scopus, Science Direct, Scielo, and IEEE Xplore databases. The inclusion criteria were studies written in English or Spanish and with a publication date until May 2021. The content had to specify that the caregivers actively participated in the co-creation process, which covered until the development phase of the technological solution (prototype). The level of evidence and the methodological quality were analyzed when possible, using the Scottish Intercollegiate Guidelines Network criteria and the Mixed Methods Appraisal Tool, version 2018, respectively.

RESULTS

In total, 410 papers were identified, and 11 met the eligibility criteria. The most predominant articles were mixed methods studies and qualitative studies. The technology used in the analyzed articles were mobile or web applications (9 studies) and specific devices such as sensors, cameras, or alarm systems (2 studies) to support the health and social aspects of caregivers and improve their education in care. The most common patient profile was older people (7 studies); 6 studies used co-creation in the requirements phase, 6 studies detailed the design phase. In 9 studies, the prototype was iteratively refined in the development phase, and the validation phase was performed in 5 of the reviewed studies.

CONCLUSIONS

This systematic review suggests that existing co-created technological solutions in the field of health for caregivers are mostly mobile or web applications to support caregivers' social health and well-being and improve their health knowledge when delivering care to patients, especially older people. As for the co-creation process, caregivers are particularly involved during development and in the design. The scarce literature found indicates that further research with higher methodological quality is needed.

Data-Driven Technologies as Enablers for Value Creation in the Prevention of Surgical Site Infections: a Systematic Review

Despite the advances in modern medicine, the use of data-driven technologies (DDTs) to prevent surgical site infections (SSIs) remains a major challenge. Scholars recognise that data management is the next frontier in infection prevention, but many aspects related to the benefits and advantages of using DDTs to mitigate SSI risk factors remain unclear and underexplored in the literature. This study explores how DDTs enable value creation in the prevention of SSIs. This study follows a systematic literature review approach and the PRISMA statement to analyse peer-reviewed articles from seven databases. Fifty-nine articles were included in the review and were analysed through a descriptive and a thematic analysis. The findings suggest a growing interest in DDTs in SSI prevention in the last 5 years, and that machine learning and smartphone applications are widely used in SSI prevention. DDTs are mainly applied to prevent SSIs in clean and clean-contaminated surgeries and often used to manage patient-related data in the postoperative stage. DDTs enable the creation of nine categories of value that are classified in four dimensions: cost/sacrifice, functional/instrumental, experiential/hedonic, and symbolic/expressive. This study offers a unique and systematic overview of the value creation aspects enabled by DDT applications in SSI prevention and suggests that additional research is needed in four areas: value co-creation and product-service systems, DDTs in contaminated and dirty surgeries, data legitimation and explainability, and data-driven interventions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41666-023-00129-2.

Patient perspectives of healthcare associated infection: "You don't know what impacts it will have on your life"

BACKGROUND

Healthcare associated infections (HAIs) are not present on admission but contracted while a patient is undergoing hospital treatment. While the prevalence of HAIs, their causes and treatments have been researched in varied contexts to date, the patients' perspectives of contracting and living with the consequences of HAI remains under-researched.

OBJECTIVE

To explore the patients' experience of having an HAI.

METHODS

We conducted a qualitative phenomenological study which drew on data from semi-structured interviews to explore the lived experiences of patients who had recently contracted an HAI while in hospital. Participants were recruited from two Australian hospitals during 2019 and 2021. Telephone interviews were conducted with ten participants by two research team members and transcripts from these interviews were qualitatively analysed using a thematic coding process to identify the patients' perspectives of contracting an HAI.

RESULTS

The participants had a range of different HAIs. The participants described how the experience of having an HAI can be very isolating and distressing from the patient perspective, with life-long implications. This contributes to our understanding of the way in which patients are impacted emotionally and mentally as a result of contracting an HAI.

CONCLUSION

There is a need for improved, person-centred communication about the source, treatment, and prognosis of HAIs. The findings from our study indicate the importance of considering patients' voices in their own health care.

The inclusion of augmented intelligence in medicine: A framework for successful implementation

Artificial intelligence (AI) algorithms are being applied across a large spectrum of everyday life activities. The implementation of AI algorithms in clinical practice has been met with some skepticism and concern, mainly because of the uneasiness that stems, in part, from a lack of understanding of how AI operates, together with the role of physicians and patients in the decision-making process; uncertainties regarding the reliability of the data and the outcomes; as well as concerns regarding the transparency, accountability, liability, handling of personal data, and monitoring and system upgrades. In this viewpoint, we take these issues into consideration and offer an integrated regulatory framework to AI developers, clinicians, researchers, and regulators, aiming to facilitate the adoption of AI that rests within the FDA’s pathway, in research, development, and clinical medicine.

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Concerns hamper the implementation of augmented intelligence in clinical practice

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Transparency and external validation increase trust in developed algorithms

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A regulatory framework is needed for adoption of augmented intelligence in medicine

Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study

Background

Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols.

Objective

The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research.

Methods

We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case.

Results

We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies.

Conclusions

PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.

Patient understanding of and participation in infection-related care across surgical pathways: a scoping review

OBJECTIVE

To explore the existing evidence on patient understanding of and/or participation in infection-related care in surgical specialties.

METHOD

A scoping review of the literature was conducted. PubMed, Web of Science, Scopus, and grey literature sources were searched using predefined search criteria for policies, guidelines, and studies in the English language. Data synthesis was done through content and thematic analysis to identify key themes in the included studies.

RESULTS

The initial search identified 604 studies, of which 41 (36 from high-income and five from low- and middle-income countries) were included in the final review. Most of the included studies focused on measures to engage patients in infection prevention and control (IPC) activities, with few examples of antimicrobial stewardship (AMS) engagement strategies. While patient engagement interventions in infection-related care varied depending on study goals, surgical wound management was the most common intervention. AMS engagement was primarily limited to needs assessment, without follow-up to address such needs.

CONCLUSION

Existing evidence highlights a gap in patient participation in infection-related care in the surgical pathway. Standardization of patient engagement strategies is challenging, particularly in the context of surgery, where several factors influence how the patient can engage and retain information. Infection-related patient engagement and participation strategies in surgery need to be inclusive and contextually fit.