The management of chronic wounds is fragmented and distributed unevenly between primary, community and acute clinicians and specialists in both public and private ambulatory care and hospital settings.
There is a real need for an integrated approach to chronic wounds from both a clinical service viewpoint but also in a wider educational and research capacity due to:
- Large and growing health problem
- Fragmented approach to management with no emphasis on prevention and maintenance of healing
- Wide number of health professionals involved in delivery of care with little coordination
- Links between community based care and hospital based care need to be improved to achieve better patient outcomes.
There is a real need for an integrated approach to both the prevention and management of chronic wounds. The Sutherland hospital has available infrastructure to house an Integrated Wound Care Clinic (IWCC) incorporating the following specialties (See Figure 4)
- Geriatrics and rehabilitation
- Vascular surgery and vascular diagnostics
- Dermatology and skin care
- Specialised nursing care
- Surgical and reconstructive support
This horizontally integrated specialist service will vertically integrate with the following community and primary care health services in order to provide a unique and innovative approach to both the treatment and prevention of chronic wounds.
- General practitioners
- Nursing homes
- Community nursing care (private and public)
Figure 3: Integrated Wound Care Centre with multilevel integration and patient centred care focus. The IWCC will integrate with other services in SESLHD
Integration with the Surgical Infection Research Group (SIRG) based at Macquarie University will provide the back up of a fully funded research laboratory to develop innovative strategies for the treatment of chronic wounds. This integration will provide an unparalleled opportunity to conduct translational research evaluating the effectiveness of new strategies and technologies to heal chronic wounds.
Industry partners involved in wound care (KCI, Convatec and Smith & Nephew) have been approached to support the running of clinical trials, educational initiatives and also contribute to infrastructure costs.
The integrated wound care centre will provide opportunities for both medical and nursing fellowships for practitioners interested in developing their skills and knowledge in this area.
The rotation of integrated registrars in medicine and surgery will provide exposure of trainees to model and provide impetus for change of culture within the specialty groups.
Current evidence favouring integration
The establishment of multispecialty wound clinics has been reported previously in the UK and the USA2. These have primarily been nursing driven without significant medical input. In spite of this, there is some evidence that having a dedicated wound centre for patients to be assessed and treated can lead to improved outcomes. Our model moves further seeking to further integrate medical and nursing specialties as well as provide links at the community and primary care level. Our emphasis on prevention of wounds, especially in diabetics is novel. Additionally, we will establish strong links with the Diabetic service in the LHD. The IWCC will also integrate with existing LHD services. These will include Diabetes, Aged Care and Rehabilitation. Additionally, there will be an outreach service to nursing homes and aged care facilities in the community. The establishment of ISCC is novel, has not been reported elsewhere and is a truly innovative concept. We have established a pilot model (Dermatology/Plastic Surgery) since July 2014.