Wound Care Team wraps successful virtual care pilot
By Mackenzie Patterson
Patients with chronic wounds also tend to live with severe comorbidities like diabetes and hypertension, which puts them at greater risk of becoming seriously ill should they contract COVID-19. While this vulnerable patient population needs to be protected from the virus, they also require frequent wound care appointments to avoid further complications, illness or death.
The St. Michael’s Hospital wound care team launched a digital care pilot program in November 2020 to reduce the need for in-person visits while maintaining quality care. The program leveraged tools like Zoom, Ontario Telemedicine Network (OTN) and an online regional wound care hub to make appointments, and house patient records, photos and other salient data required for those virtual visits.
A team of 12 experts including Sonya Canzian, Executive Vice President of Clinical Programs at Unity Health, Dr. Trevor Jamieson, Chief Medical Informatics Officer and Janeth Velandia, Nurse Practitioner for the St. Michael’s Wound Care Program, launched the program after securing $250,000 in funding from the Toronto Central Local Health Integration Network (TC LHIN) last summer.
“The Wound Care team at St. Michael’s is an interdisciplinary team and one of largest in Canada,” Velandia says. “We had already been using virtual care tools before this program, however because of this funding, we were able to make it official. It helped us to afford the human resources that made this program so successful including admin support from Caitlyn Martin and Home/Community Liaison and Occupational Therapy from Lauren Noronha.”
Velandia says the team used new technology including specialty wound care software that can measure the healing trajectory, track the progression of wounds live, and isolate data for future research. The program includes a dashboard which collates data in real time, providing projections like average wound closure time and average healing time for an individual wound or multiple wounds on the same patient.
In addition, the virtual nature of the program allowed the team to view the patient’s home environment, which helped them understand their condition from a more holistic perspective while making patients feel more comfortable.
“Seeing into the patients’ homes was helpful because we were able to get a sense of how someone lives and what their equipment and environment looked like, which helped inform our treatment recommendations,” Noronha says. “For example, if we saw that a patient had a smaller space or challenges with mobility and cognition, we could ensure their treatment plan was simplified and perhaps advocate for more assistance compared to another patient with access to more resources.”
Home visits were also beneficial for patients that were fearful of contracting COVID-19. They decreased the expense of Wheel-Trans appointments and also the duration of appointments, allowing the specialists to see more patients without impacting the quality of care.
“I am truly satisfied with all the help I received through this program,” says a patient who was involved in the pilot project. “It was amazing to be seen from home and not have to travel into the hospital. I felt a lot more comfortable this way and received great care.”
Quality wound care is more complex than just addressing the surface issues—wounds have the potential to severely affect patients’ quality of life, which is why a holistic approach involving multiple professionals like physicians, nurses, occupational therapists, chiropodists, dietitians and social workers is essential.
The team found that most patients could be seen with 24 hours of receiving the referral, with an average of seven days between referral received and initial appointment – a much quicker response rate than normal.
The wound care specialists were also able to follow up with patients more quickly to recommend uses of equipment, mobility, nutrition and more.
“The virtual program is really an extension to the in-person wound care program,” Velandia says. “It has acted as an additional layer of the service, helping us to provide better care and more frequent follow-ups.”
The lead plastic surgeon for the pilot Dr. Karen Cross says the pilot also helped to strengthen learning and collaboration across disciplines like occupational therapy and the nurse practitioner.
“For me, it enhanced communication amongst the team and other stakeholders,” she says. “At times, it was more comprehensive and we were able to learn from each other.”