Choosing Wound Care Wisely
Chronic wounds represent a significant burden to patients and the healthcare system, and can result in significant functional impairment, reduction in quality of life and large financial costs (around 2% of total health expenditure in Australia). The Choosing Wound Care Wisely project from Mackay Hospital and Health Service (Mackay HHS) in Queensland is about ensuring wound treatment is appropriate to the cause and condition of a wound, maximising clinical effectiveness, reducing patient risk, minimising cost and facilitating patient choice where possible.
Following our Choosing Wisely goals, at the Mackay HHS we are constantly looking to improve the care we deliver to the community by making the most of the resources we have. Our Catalyst program is part of the way we do this. The program encourages and enables initiatives that are based on the latest research evidence to address a significant challenge in the community and deliver improved patient outcomes without additional ongoing costs.
We saw a good opportunity to improve the way we do wound care. In many cases there is little guidance about the best dressing choice for different wound types. Clinical staff sometimes rely on guidance and advice from representatives of the manufacturers of wound dressings, but these representatives are not independent sources of clinical evidence and may not necessarily have such expertise.
Ward storerooms often include wound dressings that are not suitable for the wound types on their wards, or stock dressings that are more expensive than other, equally clinically appropriate dressings. The lack of standardisation or evidence-based selection of dressings may lead to poor patient outcomes, longer healing times and high expenditure on unnecessary dressings.
With the goal to improve our wound care, we adapted a project from the Royal Brisbane and Women’s Hospital. Wound care and procurement specialists audited each ward’s current stock of wound dressings and developed a standardised dressing selection based on patient cohort, clinical evidence and cost. To reduce the ordering of inappropriate stock, we removed dressings outside of the recommended selection. A broader range of dressings was retained in a dedicated wound clinic.
We also educated our rural facilities in wound care product selection, wound care treatment and supply management as well as introducing visual guides in each storeroom on appropriate wound dressing use.
The standardised wound dressing selection, dressing guidance and visual guides was based on the latest evidence. When there was no specific compelling comparative evidence on the relative effectiveness of one advanced wound product over another, our final wound dressing recommendation was based on respecting the patient’s choices if possible and minimising the cost.
For chronic wounds, the general advice was to use hydrogels in the debridement stage, foam and low-adherence dressings in the granulation stage, and hydrocolloid and low-adherence dressings in the epithelialisation stage.
By driving more clinically appropriate wound care across Mackay HHS with the Choosing Wound Care Wisely project, we are providing better patient outcomes. There are also financial benefits of the project, meaning that resources are freed up to deliver care in other areas.
The healthcare environment is very complex and it is often difficult to establish cause and effect relationships. For this reason, we were unable to measure or quantify clinical benefits resulting from any better (and faster) wound healing. Therefore, the primary outcome we measured was cost savings from wound dressing expenditure (which is typically 17-22% of total wound care expenditure).
Using two different measures, estimates of the annual wound dressing expenditure savings were around $70,000. These ongoing annual savings, which would be augmented by savings resulting from better wound care, clearly outweigh the one-off costs of the program of around $18,000. We have shown that providing better care does not need to cost more, and indeed, can fund itself.
The Choosing Wound Care Wisely project is not a one-off activity. Through the Mackay Institute of Research and Innovations Catalyst program, a full project evaluation has been undertaken and successful interventions from the wound care project are now used to inform new Choosing Wisely projects in other areas. We continue to improve the way we work and deliver on our Choosing Wisely goals of providing evidence-based, high value care.
Stewardship toolkit for clinical educators
The Health Resource Stewardship for Clinical educators contains educational material about the Choosing Wisely initiative for use in universities, hospitals and health professional colleges
5 questions to ask your doctor or other healthcare provider to make sure you end up with the right amount of care.