In a simulation study of surgeons' remote assessment of whether patients had surgical site infections (SSIs), researchers added photos to case vignettes. According to an article published October 24, 2018, in JAMA Surgery, having the visual reference increased the percentage of non-SSIs that surgeons correctly identified but reduced the percentage of actual SSIs correctly identified. To write the case vignettes, the researchers collected data from real cases of patients who underwent abdominal surgery at two academic medical centers, one in the United States and one in The Netherlands. The 523 US-based surgeons who participated in the study reviewed the vignettes online. First, surgeons received only the patient's symptom report and were asked whether the patient had an SSI and whether the patient had another wound abnormality that required evaluation or treatment. They then selected the next step in managing the case (e.g., tell patient to go to the emergency department, reassure the patient). Next, surgeons were given the same case but with a wound photograph and were asked to answer the same questions. Adding photos of wounds did not affect diagnostic accuracy: When diagnosing SSIs, surgeons were correct in 57% of cases when presented only with symptom reports and 58% of cases after photos were added. In 14% of cases, adding photos changed the surgeon's assessment from incorrect to correct, but in 13% of cases, the   photos changed the surgeon's assessment the other way, from correct to incorrect. In the remaining cases, the surgeon's assessment was unchanged. Surgeons felt more confident when there was a photo, regardless of whether their diagnosis was accurate or not. Surgeons were also more likely to undertriage patients when there was a photo, regardless of whether their diagnosis was accurate or not. As surgeons increasingly use telemedicine, formally or informally, to provide perioperative care, difficulties in diagnosing SSIs or other surgical site abnormalities "could create false sense of reassurance, could incur additional morbidity to patients, and could increase the surgeon's liability," the authors write. Therefore, the authors recommend continued improvement in programs for remotely assessing postoperative patients.

HRC Recommends: SSIs are costly, pose major morbidity and mortality risks for patients, lead to longer hospital stays, and are detrimental to patient recovery after surgery. Strategies to prevent SSIs include antimicrobial prophylaxis, hair removal only if necessary, blood glucose control during the immediate postoperative period, maintenance of normothermia, supplemental oxygen administration during and immediately after procedures involving mechanical ventilation, use of alcohol-containing skin prep, and use of surgical safety checklists. Surveillance can help identify SSIs and track progress. Healthcare organizations that offer surgical services or care for postsurgical patients may wish to evaluate their systems and processes for recognizing and diagnosing SSI and coordinating care with other providers.