Surgeons share how they evaluate whether a wound bed is ready for either an acellular dermal matrix or a skin graft
As the COVID-19 pandemic ravaged the globe throughout 2020, overwhelmed health officials and healthcare administrators in the U.S. canceled non-essential outpatient services and surgeries — including some wound care facilities — to minimize the spread of the virus and triage critical patients.
Alarmed at the ramifications of suspending such care, thought leaders and professional organizations sought to change course early in the pandemic. Last March, the Alliance of Wound Care Stakeholders released a statement:
The Alliance of Wound Care Stakeholders is concerned that this decision will result in unintended negative consequences that will cause a gradual influx of patients to the emergency department (ED).
Nonhealing wounds, left untreated and unmanaged, can result in significant medical issues including infection, sepsis, the need for limb amputation, and even death. As a result, many procedures provided by wound clinics are essential – not elective – to protect the health of patients and prevent an escalation of their disease.
AWCS followed through by advocating for critical wound care throughout the pandemic, including lifting Medicare and Medicaid reimbursement restrictions to keep the focus on urgent clinical care.
“For any healthcare providers who are seeing patients with chronic wounds, there is real value in recognizing that patients need to see their podiatrist, vascular surgeon, nurses, or any of the multi-disciplinary providers involved in wound care,” says Marcia Nusgart, executive director of AWCS.
The American College of Wound Healing and Tissue Repair also issued a statement in response to the closures:
…patients with non-healing wounds have been left to attempt to receive home health, if covered and available, ask friends and family and as a last resort administer self-care. Wound supplies have become difficult to obtain and patients are now left to decide if they should risk exposure in an Emergency Department filled with potential COVID-19 patients or try to get by with their own treatment plans.
With a second wave of peak cases in the U.S., wound care facilities may be shuttered once again. In fact, the California Department of Public Health recently ordered the immediate suspension of non-essential and non-life-threatening hospital services in the state.
Here’s why wound care should be deemed an essential service:
- The initial shutdown led to drastic changes in care. An analysis of 3 weeks during the 2020 pandemic compared to a year prior showed a 40% drop in wound care center visits.
- Consistent care can save limbs and lives. For instance, upwards of 25% of the 34.2 million Americans living with diabetes will experience a foot ulcer. Of those foot ulcers, 5% to 24% will result in amputation. When appropriate care is provided, amputation risk can be decreased by half, hospital admissions reduced by 38% and skilled nursing facility admissions reduced by 70%.
- The rate of wound recurrence is high. Among patients with diabetic foot ulcers, 40% will have a recurrence within a year, almost 60% within 3 years and 65% within 5 years, according to a review of 19 studies on foot ulcers.
- The population in need of wound care is large and increasing. Upwards of 8.2 million Medicare beneficiaries – that’s 15% – experienced wounds without or without infection, according to 2014 data. With an aging population, the prevalence of chronic wounds in the U.S. is poised to rise steeply.
- The cost of wound care is already sizable. Using 2014 data, wound care Medicare costs total $28 billion a year using a conservative estimate. When wound care due to a secondary diagnosis in included, that annual cost is closer to $96.8 billion.
AWCS recommends the following best practices for wound care during COVID-19:
- Adopt aggressive infection control and social distancing procedures.
- Transition wound care patients to telehealth, office visits or home health care as appropriate.
- Keep wound clinics open to treat patients facing outcomes like infection, possible amputation or death.
- Partner hospital administrations and physicians to use triage criteria when reducing essential clinical services, including wound care.