Building a Multidisciplinary Hospital-Based Wound Care Center: Nuts and Bolts

Kim, Paul J.; Attinger, Christopher E.; Steinberg, John S.; Evans, Karen K.; Akbari, Cameron M.; Mitnick, Carol Deane Benedict; Johnson‐Arbor, Kelly; Singh, Brinder

doi:10.1097/prs.0000000000002648

Cited by 28 publications

(32 citation statements)

References 23 publications

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“…Therefore, we speculate that the organization model may have a great influence on the effect of TM on wound healing; in particular, the community-based model may benefit from the implementation of TM. A possible explanation may be that in the community-based model, TM allowed patients in remote and rural settings easier access to multidisciplinary management which has been demonstrated to be an effective and efficient way of chronic wound management [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

Cao¹,

Gao²,

Chen³

et al. 2020

JMIR Mhealth Uhealth

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Background Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. Objective The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. Methods We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. Results A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. Conclusions Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

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Section: Discussionmentioning

confidence: 99%

Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

Cao¹,

Gao²,

Chen³

et al. 2020

JMIR Mhealth Uhealth

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“…Wound centers as a whole can be profitable when integrated with the hospital setting. 4,5,17,18 The high cost associated with the treatment of chronic wounds has been well established. 19 Leveraging dedicated wound care centers can help decrease overall costs associated with wound care.…”

Section: Discussionmentioning

confidence: 99%

“…However, the composition and structure of wound centers with respect to director and staffing are variable. 4,5 Surgeon involvement in wound centers has been shown to be critical to provide needed debridements, revascularizations, and amputations in conjunction with wound care as needed. [6][7][8] Despite this, little is known regarding surgeon perspectives on wound centers or their interest in participation in wound centers and wound management.…”

mentioning

confidence: 99%

Survey of Surgeons’ Perspectives of Wound Care Centers and Chronic Wound Care

Rendell

Esposito

Gibson

2019

The American Surgeon™

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Multidisciplinary management of chronic wounds using comprehensive wound centers improves outcomes. With an increasing need for wound providers, little is known about surgeons’ roles in wound centers. An online survey of two national surgical organization members covered demographics, wound center characterization, and surgeons’ perspectives of wound centers and wound care. Surgeon perspectives were compared by age, gender, and relationship status. Three hundred sixty-four surgeons responded. Respondents were mostly older than 50 years, male, in practice older than 10 years, and used wound centers. Most respondents reported favorable experiences with wound centers but uncertainty about financial details. Most respondents were interested in formal wound care certification and participation in a wound practice, particularly as a transition to the retirement option for older surgeons. Surgeons are interested in pursuing a career focus in wound care. Further efforts are needed to educate surgeons and create a pathway for surgeons to become wound center directors. In a nationwide survey, surgeon perspectives on wound centers and wound specialization were positive, although financial understanding was limited. The importance of this finding is the support of wound care pathways for surgeons.

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“…Despite this, a limited number of multi‐specialist limb‐preservation clinics or programmes exist in North America, and very few studies exist examining the structure, processes, and outcomes of care provided by these clinics or programmes to guide their creation 24 . In September 2017, based on clinical need and informed by published opinions, 21,23,25‐27 The Ottawa Hospital (TOH) Division of Vascular and Endovascular Surgery initiated a unique‐in‐Canada quality improvement initiative by opening a novel, university‐affiliated limb‐preservation clinic and programme in collaboration with colleagues from nursing, infectious diseases, and orthopaedic and plastic surgery. In this study, we sought to describe the structure, processes, and initial outcomes of TOH multi‐specialist limb‐preservation clinic and programme to evaluate the quality of care it provides and inform others' intent on designing similar clinics and programmes 28 .…”

Section: Introductionmentioning

confidence: 99%

Structure, processes, and initial outcomes of The Ottawa Hospital Multi‐Specialist Limb‐Preservation Clinic and Programme: A unique‐in‐Canada quality improvement initiative

Roberts

Murphy

Strauss

et al. 2021

International Wound Journal

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In 2017, The Ottawa Hospital initiated a unique‐in‐Canada quality improvement initiative by opening a novel, multi‐specialist limb‐preservation clinic. We sought to describe the structure, processes, and initial outcomes of the clinic and evaluate whether it is achieving its mandate of providing high‐quality wound clinical care, education, and research. We conducted a descriptive prospective cohort study alongside a nested study of 162 clinic patients requiring serial assessments. There have been 1623 visits, mostly (72.2%) from outpatients. During 17.8% of visits, patients were evaluated by >1 specialist. Therapies provided most often included negative‐pressure wound therapy (32.7%), biological wound dressings (21.6%), and total contact casting (18.5%). Furthermore, 1.2% underwent toe/ray amputations or skin grafting in clinic and 22.8% were initiated on antimicrobials. Mixed‐effects models suggested that mean wound volumes for those requiring serial assessments decreased by 1.6 (95% confidence interval = −0.86 to −2.27) cm3 between visits. The clinic provided seven rotations to vascular surgery, infectious diseases, dermatology, and palliative care physicians; three nursing preceptorships; and two educational workshops. It also initiated provincial and national vascular health and wound care research initiatives. This study may be used to guide development of other limb‐preservation clinics and programmes. Findings support that our programme is achieving its mandate.

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Building a Multidisciplinary Hospital-Based Wound Care Center: Nuts and Bolts

Abstract: The final goal is to return the patient to the best quality of life achievable given his or her wound or disability. The aim of this study is to present the authors' experiences and provide insight for others who may want to build this model within their institutions.

Cited by 28 publications

References 23 publications

Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

Survey of Surgeons’ Perspectives of Wound Care Centers and Chronic Wound Care

Structure, processes, and initial outcomes of The Ottawa Hospital Multi‐Specialist Limb‐Preservation Clinic and Programme: A unique‐in‐Canada quality improvement initiative

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