Audit Program Research Articles

Abstract 35: Impact of Artificial Intelligence Imaging Decision Support Software on Treatment of Acute Ischemic Stroke in England

Introduction: AI imaging decision support software is recommended by UK and USA stroke guidelines to facilitate identification and transfer of stroke patients eligible for endovascular therapy (EVT) but the impact on thrombectomy delivery is unclear. This prospective observational study evaluated the impact of Brainomix 360 Stroke software in four stroke networks (28 hospitals) in England’s National Health Service (NHS). The primary outcome was percentage of acute stroke patients receiving EVT (the EVT rate); door-in door-out (DIDO) times were assessed as a secondary outcome. Methods: Data were collected prospectively from the Sentinel Stroke National Audit Programme. The impact of Brainomix 360 Stroke software was assessed in two ways: comparison of EVT rates at the 28 evaluation sites and non-evaluation NHS sites before and after implementation (pre-implementation: Jan 2019-Feb 2020; post- : Jan 2022-Feb 2023); comparison of EVT rates and DIDO times at evaluation sites after implementation in patients for whom AI software was used and in those it was not. Multivariate regressions were used to evaluate whether AI use was a predictor of EVT or DIDO time, accounting for other clinical variables (e.g., age, NIHSS, day of week, time of day, time since onset). Results: The dataset included 71,327 patients from 28 evaluation hospitals. Figure 1 shows the change in EVT rates over time in evaluation (blue) and non-evaluation sites (yellow). EVT rate at evaluation sites increased from 2.3% pre-implementation to 4.6% post-implementation (p<.0001). By contrast, EVT rate at non-evaluation sites changed from 1.6% to 2.6% (p<.0001). After implementation, cases that were reviewed with AI software support were more likely to receive EVT (5.9% vs 3.6%; OR=1.6 [95% CI:1.3-1.9, p<.0001). When limiting the analysis to cases admitted to primary stroke centres, the EVT rate was twice as high in cases reviewed with AI software (4.7% vs 2.2%; OR=2.3 [1.8-3.1], p<.0001). DIDO times were shorter for cases reviewed with AI software (median 127 vs. 192 minutes; p<.0001). Conclusions: This prospective study showed that use of AI imaging software was associated with a higher rate of EVT, both by comparing pre- vs. post-implementation data, as well as by comparing cases for whom AI software was versus was not used. Use of AI software was also associated with faster time to transfer. The results support guideline recommendations for AI software to be used in clinical practice.

P-1728. Let's Settle the "Score": Implementation of a Prioritization Tool into an Antimicrobial Stewardship Prospective Audit and Feedback Program

Abstract Background Prospective audit and feedback (PAF) remains the backbone of antimicrobial stewardship (AS) action. However, PAF is time consuming and does not always result in intervention. A prioritization scoring tool is a proposed solution to improve AS efficiency. We sought to assess the impact of a scoring tool (‘score’) on the efficiency of our AS program.Figure 1.Interrupted Time Series Analysis of Intervention Rate Pre-Post Score Implementation Methods A pre-post evaluation of AS PAF at an academic medical center was performed. The pre-score period (November 2022 – June 2023) consisted of standard PAF (largely 48-hour review). The post-score period (July 2023 – March 2024) included standard PAF in addition to the score. The scoring tool is embedded within the AS surveillance system in the electronic medical record and is used to readily identify patients with opportunities for antimicrobial optimization. It consists of pre-defined “points” for each programmed alert (e.g. bug-drug mismatch=10) which are reported in real-time as a prioritized list (higher score = higher priority). An interrupted time series was conducted to compare the intervention rate pre- and post-score implementation. A subgroup analysis was conducted on the post-score period comparing the reviews triggered by the score versus the 48-hour review. A univariate logistic regression was carried out to determine the association of the score with AS intervention.Table 1.Comparison of Score Interventions vs 48-hour Review during the Post-Period Results There were 5801 AS reviews in total, 2927 pre-score and 2874 post-score (92 missing outcome data). The mean intervention rate pre- and post-score was 46.2% and 52.3%, respectively (p< 0.001), with a +2.2% difference per month (p=0.036) as illustrated by Figure 1. The change was gradual without any significant, immediate level change. The score subgroup consisted of 312 reviews and were compared to 1180 48-hour reviews during the same period. Table 1 compares the two groups demonstrating overall high intervention rate in the score group (52.6% vs 40.9%, p < 0.0001); however, notable characteristics were different. An AS intervention was 1.6 times more likely when using the score approach (OR 1.6, 95% CI 1.3 – 2.0). Conclusion Implementation of an antimicrobial scoring tool may improve PAF efficiency by better predicting patients for antimicrobial optimization than standard 48-hour review. The scoring tool can be an impactful method when performing PAF. Disclosures Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria

Implementation of Occupational Safety and Health at PT Menarini Indria Laboratories Bekasi

PT Menarini Indria Laboratories, a foreign pharmaceutical company in Indonesia, recognizes the importance of occupational safety as a critical step toward operational success. A significant focus on the Quality Control (QC) division and the Quality Control Laboratory, where drug quality testing is conducted, presents potential hazards to employees. Through the implementation of ISO 45001:2018 Standard, the company demonstrates its commitment to occupational safety and health. The results showed an excellent level of ISO 45001:2018 implementation with percentage values above 78% for each step of the PDCA cycle. Hazard Identification and Risk Assessment (HIRA) analysis helped identify potential hazards and risks in QC. Some areas, such as the use of heavy equipment, chemical spills, and laboratory operations, showed a level of risk that needed to be managed appropriately. The company has implemented appropriate controls, such as SOPs, ergonomics training, use of assistive devices, and personal protection (PPE). Proactive measures such as the Zero Accident Program and annual external audits are also implemented to achieve safety goals. Nonetheless, the company must continuously monitor and improve its safety management system to ensure a safe, efficient, and compliant working environment. By aligning ISO 45001:2018 implementation and risk mitigation strategies, PT Menarini Indria Laboratories can ensure continued operational success while providing optimal protection for its workforce.

A Teacher's Experience with Virtual Programming Lab

Here I present the experiences gained from the development and deployment of auto-graded Virtual Programming Lab (VPL) exercises for flipped class exercises in an introductory class on object-oriented programming for engineering students. Augmenting the VPL system with a unit testing framework like Java’s jUnit allows for rapid development of assessments in a manner that is consistent with engineering approaches to software development, including allowing convenient application of battery of test conditions. The integration of this assessment tool with the institutions learning management system allows for a consistent, automated, and reliable link between the assessment tool and the student grade records. Furthermore, the automated nature of these assessments, and the close ties to the learning management system make this particularly well suited to generating learning outcome and graduate attribute data at a fine level of granularity for program audits such as those carried out by the Canadian Engineering Accreditation Board.

Evaluating the Effectiveness of an Occupational Health and Safety Management System Certification Program on Firm Work Injury Rates in Alberta, Canada.

Occupational health and safety management systems (OHSMS) certification programs have the potential to improve workplace health and safety. In Canada, the Certificate of Recognition (COR) program is an example of such program and has been introduced in many industries and provinces. This study's objective was to identify whether the implementation of the COR program led to greater reduction in firm work-related injuries in Alberta, Canada. Using firm- and claim-level data from the Workers' Compensation Board of Alberta and COR registration data from Government of Alberta, the effect of becoming COR-certified on firm-level injury rates was assessed using a matched difference-in-differences study design with population-averaged negative binomial regression models. A total of 14,377 certified firms were matched with 11,338 non-certified firms during the years 2000 to 2015. Firms that became certified had a greater reduction in the lost-time injury rate (IRR: 0.86, 95% CI 0.83-0.88) and disabling injury rate (IRR 0.97, 95% CI 0.94-1.00) relative to the change in injury rates among similar non-certified firms. The effectiveness of OHSMS certification was strongest in the transportation, manufacturing and trade sectors, in more recent years, and among firms certified using the standard COR program as opposed to the program adapted for small employers. The findings suggest that COR can be an effective program, but that the effectiveness of this program is dependent on the context in which it is implemented, such as the industry sector, time period, and type of audit program.

Examining Factory Process Safety Management Systems And Studying Lean Improvement Methods

Many factories have set up a safety management system (PSM), and there is an increasing rate of safety management systems. This is increasingly in line with the development of industrial plants. External and internal inspection of security management processes are the core of Process Safety Management (PSM) and are an essential opportunity to improve operational solutions. The problems of security inspection arise due to unclear and unplanned inspection issues, resulting in unsystematic monitoring of factual information and opinions and loss of opportunities to achieve goals throughout the organization. This research aims to improve the inspection process by using computer software technology in auditing. After improving the process according to the Lean Process Management (ECRS) concept to reduce waste, the workflow was reduced by 40.74%, and 60% efficiency was increased. In addition, the assessment results from a sample of PSM auditors showed 93.4% satisfaction as the most appropriate. Therefore, this study demonstrated the potential and benefits of implementing the Process Safety Management System (PSM) audit program and applying Lean theory to improve auditing, which can be used as an essential reference for future research and program development.

When Auditing Is Not Enough: Analysis of a Central Line Bundle Audit Program.

Bundled interventions and auditing have been recommended to reduce central line-associated bloodstream infection (CLABSI) events at acute care hospitals. We review the outcomes of a bundle audit program at an adult and pediatric academic medical center from April 1, 2021, to May 31, 2022. To analyze the impact on CLABSI rates following the introduction of a central line maintenance bundle audit process. All audit survey data, CLABSI event rates, and line days were collected. Statistical relationships were evaluated for CLABSI bundle performance with CLABSI rates and audit volume with CLABSI rates. Analyses were conducted at the hospital and unit level. No correlation is found between CLABSI rates and audit performance at the hospital level (adult units, P =.619, r-sq=2.13%; peds/NICU, P =.825, r-sq=0.43%) or at the unit level (n=7; P =.8-.896, r-sq=0.15%-18.2%). There was no correlation in CLABSI rates when reviewing performance by audit volume at the hospital level (adult, P =.65, r-sq=1.7%; peds/NICU, P =.677, r-sq=1.5%) or at the unit level (n=7; P =.25-.8, r-sq=1.2%-8.5%). By contrast, a single unit that did not participate in the audit program during the sample period reported a lower CLABSI rate than comparable participating units (P =.008). During the sample period, there was no relationship found between this CLABSI bundle audit program and improvement in CLABSI performance.

Releasing time to care: a quality improvement project aimed to increase direct rehabilitation time in a Stroke Rehabilitation Centre

Stroke is a leading cause of disability among adults, and any treatment that improves functional outcome, like higher intensity of rehabilitation therapy, can significantly reduce its financial burden. Clinicians on...

Guidance and Counselling Program Audit: A Survey Method

This study aims to conduct an audit of the guidance and counseling program. This research was conducted using the survey method. The participants were 30 guidance and counseling teachers in different schools in Bandung-Indonesia. This study used a questionnaire instrument developed from ASCA (2003), and adapted according to Indonesian conditions. The instrument consists of 4 indicators (foundation, delivery, management, and accountability) covering 17 components with 110 statement items. This data collection used google form so that it was easily filled in by teachers. The data analysis used descriptive statistics by calculating the percentage of each component and indicator, then calculating the average percentage of the guidance and counseling program as a whole. The results of the average percentage of this program audit are categorized into good, fairly good, less good, and not good. The results of this study indicate that the average percentage of the overall guidance and counseling program is 78.53% (fairly good). The indicator with the highest achievement is foundation with an average percentage of 83.67% (good), and the indicator with the lowest achievement is management with an average percentage of 71.71% (fairly good). This research serves as an evaluation to see the strengths and weaknesses of the guidance and counseling program in Bandung-Indonesia. Thus, this becomes the basis for developing effective guidance and counselling programs in Indonesia in the future.

How and why do community stakeholders participate in the national stroke audit in England? Findings from a mixed-method online survey

BackgroundNational audit programmes are a recognised means of assessing quality of healthcare by collecting and reporting data in relation to evidence-based standards. The Sentinel Stroke National Audit Programme is a prospective audit of processes and outcomes for all stroke patients in England, Wales and Northern Ireland which has historically focused on hospital-based care. Evidence suggests it has been successful in driving quality improvement. What has yet to be explored is the influence of such a national audit programme on community-based healthcare. The aims of this study were to understand how community stakeholders perceive and participate in the audit. MethodsThe study used a realist approach, being theory driven and informed by collaborators including stroke clinicians and experts in realist and audit methodology. Contextual determinants and mechanisms were identified from the literature as having the potential to influence quality improvement. These were operationalised into 18 survey items, using a combination of 5-point scales and yes / no responses. Free text options offered the opportunity to expand upon responses.The online survey was distributed using social media, clinical networks and professional bodies. Representation was sought from community stroke stakeholders across England and from roles throughout the audit process including administrative, clinical, management and commissioning. ResultsThe survey achieved a national sample from a broad range of stakeholders (n=206). Participants reported being engaged in the audit, committing significant resources to participation. National audit feedback was described as being used to support a range of improvement activities, including funding for additional staff and service reorganisation. A number of factors influenced the ability of teams to participate in audit and utilise feedback for quality improvement. These included the online platform, the accuracy of data submitted and leadership support.ConclusionsFindings highlight the work needed in terms of the data captured, organisational audit support and engagement with feedback if the potential of the audit as a tool for quality improvement in community rehabilitation (as highlighted in acute stroke care) is to be realised.

Implementasi Program Audit Kasus Stunting di Wilayah Kerja Puskesmas Guntur 1

The prevalence of stunted toddlers in Demak Regency in 2021 is 25,5%. This prevalence figure is above the threshold (cut off) that has been universally agreed upon. There are 7 Community Health Centers that are the locus of stunting in Demak Regency, including Guntur 1 Community Health Center. This research aims to determine the implementation of the stunting case audit program in the Guntur 1 Community Health Center working area. This study uses a qualitative method. The informants in this research consisted of the Head of Guntur 1 Community Health Center, the Guntur 1 Community Health Center Nutritionist, the Village Midwife, Cadres from Temuroso Village and Tlogorejo Village, as well as mothers of stunted and non-stunting toddlers. Data collection through in-depth interviews, observation and documentation. The result of this research indicate that the implementation of the stunting case audit program in the Guntur 1 Community Healt Center working area is quite good. The actor categories, decision making, benefits, program implementers, actor strategies, action programs, communication and bureaucratic structures are good. In the categories of resources and compliance and responsiveness there are problems and obstacles. The suggestion of this research is for the community health center to increase intervention with the community in preventing stunting.

Strengthening crisis resilience in German primary care by using quality indicators: findings of a process evaluation in the RESILARE project

BackgroundIn recent years, health systems worldwide have been confronted with several crises such as natural disasters or the COVID-19 pandemic, that affected lives and health of many people. In light of waves of infections and heat, climate change is considered to be the biggest health threat of the 21st century. Strengthening individual and organizational crisis resilience in healthcare settings thus becomes a crucial factor in maintaining care quality and protecting vulnerable patients during such crises. The RESILARE project therefore aimed to develop and evaluate quality indicators that support primary care practices in preparing for and adapting to crisis-related challenges.MethodsIn a three-phased process, indicator development was based on systematic literature research and qualitative data, a two-stage expert panel process, and pilot testing in a maximum of n = 35 ambulatory practices during an outreach visit. Practice-individual indicator-related status and benchmarking information were provided via feedback reports to complete the audit and feedback program. A mixed-methods process evaluation used semistructured interviews with participating General practitioners and nonphysician health professionals to explore support and challenges for the implementation of the derived set of quality indicators. Two online surveys were conducted to evaluate all indicators and the two-part feedback report. Qualitative data were analyzed inductively using a thematic analysis approach. Survey data were analyzed descriptively.ResultsA total of n = 32 indicators covered four domains: (1) individual resilience, (2) crisis prevention, (3) organizational resilience, and (4) climate resilience. N = 34 practices participated in the piloting and the process evaluation. Participants generally attributed a high relevance to the domains, and considered the indicator set suitable for implementation into existing quality management systems. Planning and implementation of measures that strengthen crisis resilience in practices were triggered or intensified by piloting the indicators and by the two-part feedback report. The identified challenges involved the volume of indicators and practice-individual implementation of renewable energy sources on rented premises. Participants expressed their desire for peer exchange regarding proven concepts for crisis resilience.

Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study

Abstract Background The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations. Methods In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this. Results 9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received. Conclusion Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.

Adiposity and mortality among intensive care patients with COVID-19 and non-COVID-19 respiratory conditions: a cross-context comparison study in the UK

BackgroundAdiposity shows opposing associations with mortality within COVID-19 versus non-COVID-19 respiratory conditions. We assessed the likely causality of adiposity for mortality among intensive care patients with COVID-19 versus non-COVID-19 by examining the consistency of associations across temporal and geographical contexts where biases vary.MethodsWe used data from 297 intensive care units (ICUs) in England, Wales, and Northern Ireland (Intensive Care National Audit and Research Centre Case Mix Programme). We examined associations of body mass index (BMI) with 30-day mortality, overall and by date and region of ICU admission, among patients admitted with COVID-19 (N = 34,701; February 2020–August 2021) and non-COVID-19 respiratory conditions (N = 25,205; February 2018–August 2019).ResultsCompared with non-COVID-19 patients, COVID-19 patients were younger, less often of a white ethnic group, and more often with extreme obesity. COVID-19 patients had fewer comorbidities but higher mortality. Socio-demographic and comorbidity factors and their associations with BMI and mortality varied more by date than region of ICU admission. Among COVID-19 patients, higher BMI was associated with excess mortality (hazard ratio (HR) per standard deviation (SD) = 1.05; 95% CI = 1.03–1.07). This was evident only for extreme obesity and only during February–April 2020 (HR = 1.52, 95% CI = 1.30–1.77 vs. recommended weight); this weakened thereafter. Among non-COVID-19 patients, higher BMI was associated with lower mortality (HR per SD = 0.83; 95% CI = 0.81–0.86), seen across all overweight/obesity groups and across dates and regions, albeit with a magnitude that varied over time.ConclusionsObesity is associated with higher mortality among COVID-19 patients, but lower mortality among non-COVID-19 respiratory patients. These associations appear vulnerable to confounding/selection bias in both patient groups, questioning the existence or stability of causal effects.

The Role of Activating Joint Audit Programs in Reducing The Exchange Rate Volatility Risks "A Field study"

The Role of Activating Joint Audit Programs in Reducing The Exchange Rate Volatility Risks "A Field study"

Current Application of the Medical Device Single Audit Program (MDSAP) as a Global Regulatory Reliance Framework for the Inspection of Medical Devices.

The globalization and rapid advancements in medical technologies necessitate the harmonization of international regulatory frameworks to ensure the efficient and timely clinical application of medical products, including pharmaceuticals and medical devices. Regulatory reliance, a critical component of this harmonization process, is a powerful tool that provides efficient access for economic entities and regulatory authorities, promoting predictable decision-making and accelerating approvals. The Medical Device Single Audit Program (MDSAP) serves as a regulatory reliance framework for medical device inspections. Implemented by countries including Japan, the United States, Canada, Australia, and Brazil, MDSAP allows third-party certification bodies, recognized by these regulatory authorities, to conduct audits on medical device manufacturers. The outcomes of these audits are shared with the regulatory authorities, who use them for regulatory assessments and decision-making. Since transitioning to its implementation phase in 2017, MDSAP has been widely utilized in various countries. This review provides an overview of the adoption and utilization of MDSAP in major countries, exploring the program's impact on regulatory processes and its potential as a method of regulatory reliance to facilitate timely access to effective and safe medical devices.

The Impact of Account-Level Inspection Risk on Audit Program Planning Decisions

SYNOPSIS Prior research suggests oversight inspections lead to unintended consequences by motivating auditors to manage inspection risk. The current study provides evidence of the impact of a misalignment between inspection and mis-statement risks at the account level, where planning decisions are made. We predict auditors feel pressures to address more immediate inspection risks at the expense of adequately responding to mis-statement risks as prescribed by auditing standards. Employing an experiment with 182 experienced auditors, we manipulate account-level inspection risk (low or high). As hypothesized, auditors plan more hours for an account with higher inspection risk and correspondingly assign fewer audit hours to other accounts with lower inspection risk, even if mis-statement risk is high for those accounts, suggesting an unwarranted shift in audit efforts. Our findings suggest inspection risks impair auditors’ effort allocation decisions and thus may undermine the audit risk model as the normative benchmark for program planning. Data Availability: Contact the second author. JEL Classifications: M42; M48.

National Surgical Quality Improvement Program audit of contemporary perioperative care for radical cystectomy.

To examine the impact of increased compliance to contemporary perioperative care measures, as outlined by enhanced recover after surgery (ERAS) guidelines, among patients undergoing radical cystectomy (RC). From the National Surgical Quality Improvement Program database we captured patients undergoing RC between 2019 and 2021. We identified five perioperative care measures: regional anaesthesia block, thromboembolism prophylaxis, ≤24 h perioperative antibiotic administration, absence of bowel preparation, and early oral diet. We stratified patients by the number of measures utilised (one to five). Statistical endpoints included 30-day complications, hospital length of stay (LOS), readmissions, and optimal RC outcome. Optimal RC outcome was defined as absence of any postoperative complication, re-operation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable regressions with Bonferroni correction were performed to assess the association between use of contemporary perioperative care measures and outcomes. Of the 3702 patients who underwent RC, 73 (2%), 417 (11%), 1010 (27%), 1454 (39%), and 748 (20%) received one, two, three, four, and five interventions, respectively. On multivariable analysis, increased perioperative care measures were associated with lower odds of any complication (odds ratio [OR] 0.66, 99% confidence interval [CI] 0.6-0.73), and shorter LOS (β -0.82, 99% CI -0.99 to -0.65). Furthermore, patients with increased compliance to contemporary care measures had increased odds of an optimal outcome (OR 1.38, 99% CI 1.26-1.51). Among the measures we assessed, greater adherence yielded improved postoperative outcomes among patients undergoing RC. Our work supports the efficacy of ERAS protocols in reducing the morbidity associated with RC.

Six-month post-stroke review provision across southwest England: a service evaluation

Background/Aims Six-month post-stroke reviews are advocated for all stroke survivors. There is no recommended service model, with many variations in practice. The aim of this service evaluation was to describe and evaluate the 6-month post-stroke review service provision across the South West England Integrated Stroke Delivery Networks. Methods A mixed-methods service evaluation for 10 services was undertaken, consisting of: a stakeholder meeting to define the scope and review criteria; a mapping exercise to define core service features and activity data; a 12-month retrospective Sentinel Stroke National Audit Programme clinical data audit plus a 1-month prospective audit detailing identified unmet needs, actions to address needs and patient satisfaction; service provider and user guided discussions; and options appraisal synthesising data from all sources to inform service development. Results Considerable variations in service configuration, processes and outcomes existed across services. Guided discussions with 40 service users and 20 service providers revealed predominantly positive experiences. There was perceived value in the review, a key ingredient being its person-centred nature. However, some felt that the review was generic and more of a tick-box exercise. Many staff appeared unaware of differing 6-month post-stroke review models across the region and rarely used Sentinel Stroke National Audit Programme data to reflect on service outcomes or inform service development. Sharing of good practice across services appeared limited. Conclusions Data did not support a specific preferred service model. Findings suggested 6-month post-stroke reviews should not be a ‘one size fits all’ model, with flexibility in format and timing to optimise value. A knowledge sharing and evidence-based culture should be encouraged to nurture service development.

Post-discharge surgical site infection surveillance using patient smartphones: a single-centre experience in cardiac surgery

Background/Aims Surgical site infections following cardiac surgery pose significant risks and financial burdens to both patients and healthcare systems. This study aimed to explore the implementation and outcomes of a novel surgical wound monitoring system using patient smartphones for post-discharge surveillance. Methods The study was conducted at a London-based cardiothoracic tertiary referral centre, where 1358 patients undergoing cardiac surgery between January 2021 and March 2023 were enrolled onto the surgical wound monitoring system. Data were collected from the National Cardiac Audit Programme dataset, the monitoring syste and Hospital Episode Statistics data. Comparisons between patients who did or did not respond to surveillance requests were performed. A nested confirmatory analysis assessed antibiotics reported by patients through the digital route compared with antibiotics given by GPs or in outpatients. Results The overall response rate for surgical wound monitoring using patient smartphones was 86.6%. Patients who were female, from areas of higher deprivation and lived closer to the hospital were less likely to engage with surgical wound monitoring. Although not statistically significant, the current study suggests that patients with surgical site infections who used smartphones for surgical wound monitoring were less likely to be re-admitted or have further surgery and had shorter readmission stays. The accuracy of antibiotic use for surgical site infections using the surgical wound monitoring system was 96.5%. Conclusions This study underscores the potential of digital technologies, particularly smartphones, in efficient and accurate post-surgical monitoring. The findings suggest that the use of digital monitoring systems may improve patient outcomes, with potential for wider system-level benefits.