Here's My QR, So Call Me Maybe: Facilitating Communication in Free Flap Monitoring Using QR Code Printed Dressing

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Dear Sir,

Flap monitoring following free tissue transfer is a standard practice in high-volume microsurgical centers. It is well-understood that upon identification of vascular compromise, prompt re-exploration in theater is directly correlated with a higher chance of successful salvage.[1] For such prompt actions to occur, a well-established escalation protocol should be in place and rapidly implemented when required to allow prompt assessment by a senior clinician to determine the need for re-exploration.

A common barrier to prompt implementation of this process is the inability to contact the appropriate responsible clinician for each patient. This is particularly true in units with multiple microsurgeons with busy practices. Other barriers include the time required to read through clinical notes to review key facts in operation notes and postoperative instructions. Due to the nature of surgical training programs in the United Kingdom, trainees are frequently rotated between different units and can have irregular shift working patterns. Consequently, on-call commitments are often swapped to facilitate leaves, resulting in occasional confusion about who would be the first point of contact for clinical problems. We have found that reliance on the switchboard can unnecessarily delay escalation due to the number of operators available during out of hours.

To tackle these aforementioned obstacles, we have developed a novel strategy. Considering the increasing role of mobile computing devices in current microsurgical practice,[2] [3] we have designed stickers with case-specific QR codes which can be adhered to the top of dressings protecting the flap. These QR codes lead to a list of contact details of senior clinicians responsible for the care of the patient with a flap in difficulty. Additionally, specific postoperative instructions and critical information are included to allow quick reference without leaving the bedside. A model of such strategy is demonstrated in [Fig. 1], with the key reference which the QR code leads to in [Fig. 2].

Fig. 1 A model of our novel strategy displaying a sticker with a case-specific QR code adhered to the dressing. Fig. 2 The key reference linked to the QR code in [Fig. 1], containing contact details of senior clinicians, specific post-operative instructions, and critical information for quick reference.

It is undeniable how information technologies have changed microsurgical practice in recent years. From a human factors perspective, mobile computing devices offer expedited communication channels, which can be particularly useful in time-sensitive scenarios.[4] Our practice will likely continue to change as artificial intelligence applications become widely available.[5] Our QR code presents a smooth interface to access relevant information from the patient's bedside, which could also serve as a point of entry to other clinical platforms.

We are planning to obtain approval to implement and trial this approach. Due to patient confidentiality, we envisage the information to be uploaded on the hospital's electronic patient record within the intranet, thus preventing access by unauthorized individuals. As our trust already has hospital smartphones with intranet access for nurses to record clinical observations, the devices can be used to access the QR code information without the risk of breaching confidentiality. Using this QR code to direct junior clinicians and nursing staff to crucial information, as above, would reduce the time taken to review patient records and contact the switchboard. This will enable prompt communication, contributing to faster decision-making, thus facilitating an earlier return to the theater when required. It is important to reiterate that our proposed strategy should only be considered complementary to the existing gold standard of bedside handover with vigilance in observation and prompt escalation. As part of this project, we would like to determine patients' views of having such information attached directly to their dressing and user experience from nursing staff and junior clinicians.

Publication History

Accepted Manuscript online:
11 April 2023

Article published online:
10 May 2023

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