Current challenges and opportunities in wound care — 3 CNOs weigh in

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Wound care costs the U.S. healthcare system an estimated $50 billion annually. The large fiscal burden suggests wound care may be an overlooked target for quality improvement and cost reduction initiatives, according to Jacksonville, Fla.-based Healogics, the nation's largest provider of advanced wound care services.

                                           This content is sponsored by Healogics

More than 30 million diabetics and 28.4 million individuals with heart disease reside in the U.S. Both morbidities represent public health epidemics and carry a heightened risk for chronic wound development. Approximately 6.7 million Americans are afflicted with chronic, non-healing wounds. This figure does not account for wounds attributable to conditions such as necrotizing fasciitis and surgical wounds related to the operating room. The Healogics team asserts that these numbers suggest America is experiencing a chronic wound epidemic.

On April 11, at Becker's Hospital Review 9th Annual Meeting in Chicago, Arti Masturzo, MD, executive vice president of clinical innovation with Healogics, led a group of hospital leaders in a discussion on current challenges and opportunities related to wound care.

"We consider [chronic wounds] an epidemic because wounded patients are diabetic and heart disease patients," Dr. Masturzo said. "Healthy patients don't get chronic wounds. Healthy patients heal. If they're not healing, there are underlying [health] issues that have to be addressed."

Healogics has more than 700 wound care centers across 46 states and provides care at about 300 skilled nursing facilities nationwide. More than 300,000 patients receive treatment through the Healogics' network every year. The company has been working with hospital partners to develop inpatient wound care programs. For such programs to thrive, challenges related to cost and quality in wound care services must first be fully accounted for.

Wound care challenges

Chronic wound care creates a number of challenges for hospitals and health systems, including surgical amputation costs, which account for $8 billion in healthcare spending nationwide every year. While developing its inpatient wound care program, Healogics sought feedback from about 50 hospital partners on what they considered the most pressing challenges related to wound care.

The top five challenges identified by the hospital leaders were:

  • Achieving efficient and seamless care transitions
  • Decreasing the cost of care
  • Retaining patients
  • Decreasing hospital-acquired conditions, such as pressure ulcers and surgical-site infections
  • Improving the patient experience

During the April 11 discussion, Dr. Masturzo asked hospital leaders to comment on which of the challenges they feel is most hindering the adoption of strong inpatient wound services at their organizations and suggest what changes to wound care services would compel hospital leaders to make this critical health issue a greater priority.

The CNO of a regional hospital in the Northwest said finding providers who are already proficient or willing to be trained in wound care is a significant challenge for her organization. "We try to recruit nurses, but not many want to be trained [in wound care] and if we do train them, someone else will likely recruit them [away from the facility]," the CNO said.

Another CNO from a faith-based, nonprofit health system on the East Coast that serves 200,000-plus patients every year added that leaders from her system would be more inclined to prioritize wound care services if the program emphasized wound prevention.

"I find wound care in inpatient programs to be very reactive," the CNO said. "What I would find more compelling is if a part of it was prevention. My observation in a lot of hospitals is that inpatient wound care teams don't have a lot of new talent from a nursing perspective and the services are generally old in thought, but [a program] that places value on newer thought and includes some component of prevention, then you've got my attention."

Acknowledging that providers and hospital leaders often overlook wound care as a viable target for quality improvement initiatives, Dr. Masturzo asked leaders for best strategies in gaining support for wound care services. One CNO from a 10-hospital health system in the Midwest suggested sharing wound care success stories could simultaneously highlight the serious burden wounds place on patients and offer examples of how prioritizing wound care can benefit a hospital's bottom line. The CNO said sharing success stories from her hospital's ostomy and wound care program helped promote provider buy-in.

Opportunities for success

During the discussion, Dr. Masturzo highlighted the integration of ostomy and wound care services as a highly effective opportunity for reducing the burden of wounds on patients and health systems. Improving ostomy services is essential to bolstering a hospital's overall ability to address patient wounds, as a significant portion of wound care patients also have an ostomy.

According to the Agency for Healthcare Research and Quality, about 120,000 patients receive some type of ostomy, whether it be colostomy, ileostomy or urostomy, every year. Ileostomy alone carries the second highest 30-day readmission rate among the 30 most frequently performed surgical services. More than 29 percent of ileostomy patients are readmitted to the hospital within 30 days of discharge. Research has found improving ostomy care processes and pre-op patient education can significantly reduce the occurrence of ostomy-associated complications. 

Healogics' integrated approach to wound care leverages technology to deliver analyses on hospital wound care culture and performance. Early results from the implementation of this technology at a Midwestern healthcare site suggest the care system contributed to significant decreases in length-of-stay among wound care patients.

Dr. Masturzo said Healogics' multidisciplinary approach to wound care aids in the development of a streamlined wound care treatment plan upon patient admission. This focuses the care process, boosts the patient experience and helps to control length of stay.

"I wake up every day thinking about wounds," Dr. Masturzo told the room of executives. "We [at Healogics] are committed to advancing wound healing everywhere we can by the best means available."

To learn more about Healogics, click here.

More articles on quality:
Study: Overworked nurses may be linked to 40% increase in risk of patient death
Study: Only 30% of infants exposed to hepatitis C receive screening
Taking aspirin once per day increases skin cancer risk among men

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