Clinical Services

ePoster Presentation

(EP-101) Accessible Communication Tools for SSI Monitoring and Prevention: EpxDecolonization and EpxWound

Presenter(s)

• HM

  Hera Maryam, BS

  Medical Student
  Washington University in St Louis School of Medicine

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose

Co-Author(s)

• CC

  Christopher Chermside-Scabbo, BSE

  NA
  Washington University School of Medicine

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose
• CY

  Craig Yugawa, BA

  Medical Student
  Washington University School of Medicine

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose
• BA

  Bola Aladegbami, MD PhD

  General Surgery Resident
  Washington University in St Louis School of Medicine

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose
• TS

  Theresa St John, MSN, RN, ONC

  Nursing Administrator of Joint Reconstruction Services
  Barnes-Jewish Hospital

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose
• AC

  Angela Concepcion, BSN, RN, ONC

  Clinical Nurse Coordinator
  Barnes-Jewish Hospital

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose
• JC

  John Clohisy, MD PhD

  Medical Director, Orthopaedic Inpatient Services
  Barnes-Jewish Hospital

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose
• KL

  Keyin Lu, MS

  NA
  Saint Louis University School of Medicine

  Participants should be aware of the following financial/non-financial relationship:
  Nothing to disclose

Objectives
Demonstrate patient engagement and satisfaction with automated text message and phone call system EpxDecolonization and EpxWound. Attendees can expect to learn that automated communication tools involving SMS text messaging or phone calls (Including to land lines) are well received by patients. Patients think that the tools improve communication with their physicians and improve their care. Daily messages involving three to four questions maintains high response rates and patients think that the messages are sent at the right frequency. The benefits of such a system compared to a electronic health portal involving emails, or an app or other telemedicine platforms involves ease of use for both patients and providers, and improvement of communication between patient and provider without increasing the burden on the provider.

Methods
We conducted a perioperative quality improvement (QI) project for patients undergoing primary joint reconstructions at an academic tertiary care facility (Barnes-Jewish Hospital) from October 2015-September 2016. We designed two automated text messaging and calling systems named EpxDecolonization and EpxWound. EpxDecolonization reminded patients of their pre-operative decolonization therapy while EpxWound monitored pain, wound and fever status post-operatively. Patients were offered the option to enroll in the EpxDecol and EpxWound systems in addition to the standard perioperative care. Patient responses were recorded, and a post-usage survey was sent out to assess how the systems performed. An electronic survey using a 1-9 response scale was delivered in order to assess the care delivered by the provider, the number of messages they received, and whether the EpxDecol and EpxWound improved communication with their doctors.


Results
EpxDecolonization had 666 patients enrolled with a 96% response rate, while EpxWound had 695 patients enrolled with an 89% rate over the course of the 40-week study. The range of response rates fluctuated between 88% and 100% for EpxWound and 77% and 100% for EpxDecol. Enrollment into the system started at 5% of the total patients undergoing hip replacement in a given week and grew to enrolling 80% of the population by week 34 of the QI project. By the end of the 40 week period, an average of 55 patients were enrolled and actively using the system each week. The median score for the overall care that the patient perceived was 9/9, and the median score for whether Epx systems improved communication with providers was 8/9. The majority of patients indicated that the systems sent out the optimal number of messages.

Conclusion
EpxDecol and EpxWound systems demonstrated high response rates, high patient engagement and improved patient communication with providers. EpxDecol and EpxWound have the potential to improve outcomes by improving compliance with pre-operative protocols and post-operative wound monitoring. The majority of patients felt that the Epx systems improved the communication they experienced with their providers; the majority of patients also felt that the system sent out the appropriate number of messages. Patients, nurses, and surgeons all liked using the systems. EpxDecol and EpxWound have the potential to improve perioperative care within orthopaedics, and similar systems are being developed for other surgical subspecialties.