Surgeons share how they evaluate whether a wound bed is ready for either an acellular dermal matrix or a skin graft
With the first surges of COVID-19 cases, many wound centers across the U.S. closed to reduce potential exposure risk. Wound care centers that were able to remain open saw a 40% drop in patient volume, as its main clientele, largely consisting of higher risk seniors, felt unsafe leaving their homes.
This introduced a greater reliance on telehealth, which allows patients to remain safely in their own home while receiving the care they need via the phone or internet. Although telehealth services existed before the COVID-19 pandemic, remote care spiked as much as 154% during the last week of March in comparison to the same time the previous year.
Telehealth can be especially effective in wound care because visualization of the injuries can be achieved via home technology. Personal devices such as laptops or smart phones enable patients to directly send images and video to their physicians in real-time, synchronously. Additionally, there is also the option of an asynchronous modality, which allows for delayed communication – giving you the opportunity to store and transfer patient information from one site to another and respond to the patient later. In fact, screening of chronic wounds using mobile had a diagnostic agreement of 90% compared to in-person consultations.
In addition, advanced wound dressings can be sent directly to patients’ homes in single-dose packaging, so that you can walk them directly through the steps needed to apply the dressing during your remote consultation.
Whether you are launching telehealth wound care for the first time or ramping up existing services, it is important to keep the following best practices in mind in order to maintain the highest quality and accuracy of patient care:
Let patients know about technology and onboarding requirements prior to their appointments.
Consider sending your patients and/or their caregivers a list of the necessary technology requirements prior to appointments to give them the opportunity to ask any questions and obtain any devices in advance. This pre-visit telehealth guidance should also suggest that patients and caregivers find a quiet location with good lighting for the appointment. The guidance can also include any necessary consent forms or whether they will need to register for your telehealth system ahead of time.
Take the time to address all technological concerns in order to help alleviate any stress regarding this new method of care. Make sure the patient knows what to do in the event of connectivity issues and provide an alternate means of contact should that occur.
Acknowledge potential privacy issues.
Make sure the patient is aware of who will be in the room with you during the appointment and ask if they have any questions or concerns regarding you or your staff. Likewise, ask patients if they will have anyone in the room with them during your appointment, and make sure they are okay with that person hearing confidential information.
Use effective communication practices.
When addressing patients via video chat, it is important to give them your full, undivided attention. Be sure to mute any notifications or applications on your device to prevent any unnecessary background noise and distractions. Ensure that your webcam is positioned at eye-level, speak clearly and pause to allow for any delays. Verbalize all your actions, such as taking notes or looking away from the screen, so that your patients can feel comfortable knowing that they are your main priority at all times.
Especially in the presence of new patients, make sure to wear your white coat and badge in order to set a professional tone – some patients may be especially wary about receiving treatment from a doctor via the internet. Assure them that you will maintain quality and honesty of care within this unique situation.
Be innovative with alternate methods of examination.
While certain cases will require the patient to come in for an in-person visit, some methods of treatment and diagnosis can be tweaked to allow the patient to remain in their home.
For instance, there are new apps that allow patients to take a photo of their wound and the app will calculate its exact dimensions, which can be sent to you directly for analysis and diagnosis. There have been great strides in remote patient monitoring technology such as a temperature-sensing mat that detects 97% of diabetic foot ulcers as early as 5 weeks before the onset of symptoms.
It may not always be possible to make a diagnosis after a single telehealth visit – certain cases will require follow-up visits or additional testing and consultation. The main goal overall should be to acquire as much information as possible to determine next steps in care.
Telehealth is a revolutionary adaptation to maintaining normalcy amidst the restrictions of the current pandemic. While it requires adjustments and alterations to your normal method of practice, it can be an incredibly useful tool in wound care examination and diagnosis. Best of all, it gives your patients the peace of mind they need to ensure that they are still being cared for in a manner that is accurate, efficient, and, above all, safe.