The Selfi wound study: self-taken images of surgical wounds

Exploring the feasibility of collecting patient/carer-taken images

of surgical wounds after leaving hospital

Rhiannon Macefield

Senior Research Associate, University of Bristol

Surgical site infection (SSI)

• Accurate assessment is challenging

• Many problems occur post-discharge

Wound Healing Questionnaire

• Designed for patient or healthcare professional completion to ascertain SSI after discharge

Wound images

• Supplementary data for ascertaining SSI

• Advantages for blinded outcome assessment

Aim

• To explore the feasibility of a method for the collection of self/carer-taken images of primary surgical wounds after leaving hospital

Pre-test

EvaluateRefine

Face-to-face

cognitive

interviews with

patients/carers

Phase A:

development and pre-testing

Phase B:

remote pilot

Remote pilot

Follow-up

telephone

interviews

Draft photography

instructions & system for

uploading images

Wound photography

Existing guidance

e.g. Institute of Medical Illustrators National Guideline 2012

1. Preparation – clothing, cleaning, dressing removal

2. Location where photo is taken

3. Type of camera

4. Lighting, use of flash

5. Background

6. Position of participant

7. Distance from wound

8. Framing / use of zoom

9. Angle / plane of camera to wound

10. Focus

11. Shadows

12. Resolution

13. Calibrated colour

14. Use of scaling tool (i.e. ruler)

15. Identifiable body markings

16. Processing, downloading, labelling images

17. Participant ID

18. Storage

Considerations for photographing wounds

Photography

instructions for

participants

System for transmitting images

• Electronic ‘survey’ with facility to upload images

• Additional questions e.g. demographics, device used, experience with technology, time

• Online completion, suitable for use with mobile devices

Phase A: pre-testing

• Face to face cognitive interviews (n=16)

• Patients undergoing abdominal and vascular surgery

• Recruited from 2 NHS trusts

• Mean age 51, range 27 to 85

• Challenges - e.g. no flash with front facing camera, body piercings

• Majority were able to take and transmit images

• Refined instructions and system for uploading

Phase A: findings

Phase B:

Remote pilot

Surgery

Follow up phone call

Phone call / email

remindersPhotography instructions

Email with link to upload images + simple survey

2-3 weeks

Hospital discharge

Inclusion criteria

• Patients undergoing abdominal or vascular surgery

Access to smart phone / other device with camera

Access to email

Willing to take photograph of wound

Participants (n=61)

• Median age: 53, range 21 to 84

• Ethnicity: 97% white

59%

41%

Participants (n=61)

• 56 (92%) abdominal, 5 (8%) vascular surgery

Elective (66%)

Unplanned (33%)

Laparoscopic (54%)

Open surgery (43%)

• Median number of wounds: 3, range 1 to 5

Response rates

• Number of participants uploading images: 32/61 (52%)

• Without a reminder: 18/32 (56%)

• With a reminder: 14/32 (44%)

• Median time to respond: 4 days, range 0 to 24

• 2 further participants took images but did not upload to system

Survey results

• Devices used to take images

27 (84%) smart phones

5 (16%) tablets

• Majority (84%) took < 5 minutes

• Experience with using deviceNot experienced 1 (3%)

Somewhat experienced 3 (9%)

Moderately experienced 10 (31%)

Very experienced 15 (47%)

Expert 3 (9%)

Survey results

• 44% took images themselves

• 84% uploaded images without help

Wound images

Wound images

Image quality assessment

• Focus

• Lighting

• View of wound – entire wound, obstructions

• Adherence to instructions e.g. includes measurement ruler, no shadows, clothing, plain background

Wound assessment

• Bluebelle Wound Healing Questionnaire (WHQ)

Median score = 5 range 0 to 11

• Time since surgery: median 29 days, range 17 to 51

Challenges

• Dressings

• Email addresses

• Response rates

Summary and future work

• Simple method for taking and transmitting images using participants’ own devices

• Remote collection of clear, standardised images is possible; reminders are key

• Explore ways to increase response rates e.g. using text messages

• Explore real-time data collection; use of images for remote SSI assessment; supplement to WHQ data

Acknowledgements

Kerry AveryJane Blazeby

Barney ReevesAnni Skilton

Jonathan ReesAnne Pullyblank

UHBristol and North Bristol NHS Trust surgical research teams

Please contact: r.macefield@bristol.ac.uk