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Telemedical Wound Assessment

Denmark Distance monitoring
Telemedicinsk Sårvurdering (Telemedical wound assessment) is a two-part intervention, which consists partly of a wound record (pleje.net) which is used as a documentation tool and for telemedical communication between healthcare professionals, and an organizational intervention in the form of changes in cooperation, workflows and competence development across sectors. The project uses the solution for patients with diabetic foot ulcers and venous leg ulcers. Telemedical wound assessment is a communication and collaboration tool used by health professionals in the treatment of patients with wounds. Telemedical wound assessment can in principle be used for all types of wounds, but in project National Distribution of Telemedical Wound Assessment is limited to diabetic foot ulcers and venous leg ulcers.
There is great satisfaction with the technical solution and the competence development carried out by the staff in municipalities and hospitals. The collaboration and communication between municipal nurses and hospital staff has, according to the staff, been improved. In addition, the staff experience a number of other benefits, including that there are fewer outpatient visits per patient care. On the other hand, the staff in the hospitals do not find that this has released time. There have been several challenges in the implementation; Among other things, it has been uncertain what roles and decision-making skills the different project groups have had, and in several places the project has been driven by "enthusiasts" and there has been no management support. The present studies have also shown great satisfaction in the patients.
The solution is mainly being used for patients with diabetic foot ulcers and/or venous leg ulcers. Around 1000 patients are being treated with the solution every month.
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Telemedical wound assessment consists of a digital wound record as well as organizational changes in relation to collaboration across sectors and workflows.

Quotes/testimonials

"It was a big change for me suddenly to be a wounded patient, and I stayed at home for a long time. I was afraid of losing my leg. When the wound became a little better, I wanted to go back to work as a train driver, but then I would not have time to commute to the hospital every other day. Telemedicine meant that I could take care of my work because the treatment was so close to my home and - and I also stopped smoking.”

– Ole Holgersen, wound patient.

Elaboration

Needs and challenges

Patients with a need of wound assessment will often spend lots of time going back and forth to the hospital. The solution makes a complete difference to the working people because they are still able to go to work, and for the more fragile patients it means that they experience a higher quality treatment. The specialists in the hospital experience that they have the same number of visits but that the wounds they access are more complicated than earlier.

Pleje.net has made it possible to document the patient’s treatment course better and more uniformly. The employees experience that the system's structure creates a more structured and systematic workflow with documentation. It improves the quality of the notes received by the hospital staff from the municipal wound nurses. Both parties also benefit from the fact that all documentation from the patient process is in one place and that patients no longer have to transfer documents from therapist to therapist.

Solution and function

In telemedical wound assessment, there is no change in treatment, but in the way, it is delivered and by whom it is delivered.

A municipal nurse can supervise the citizen/patient in their own home or at the municipal health clinics, and send a picture of the wound to the doctors or nurses at the hospital via pleje.net.

Implementation

The project "National dissemination of Telemedicine Wound Assessment" is unique and the first national implementation project of telemedicine across sectors in Denmark and was implemented between 2012 and 2015.

The system administration is handled by one region on behalf of all regions and municipalities. The system administration involves, among other things, follow-up on daily operations with the supplier, budget management, secretarial service of the user group and the business control group, respectively, and coordination of development measures.  

The implementation across municipalities and hospitals have been challenged by the difference between sectors. Each region has together with municipalities formed their own implementation plan adjusted regional and local conditions. 

Economy

The precise amount of money spend and saved is not yet estimated, but it seems that the treatment costs over a six month period is decreasing.

Potential cost reductions: 

  • Costs related to patient transport to the hospital are lowered.  
  • Costs related to hospitalizations are reduced because the wounds are treated in an earlier state. 
  • The hospitals get fewer acute visits. 

Costs related to implementation: 

  • Many municipalities will have to invest in telemedical equipment  
  • More patients are treated in the municipalities so they will have extra costs  
  • Costs related to education and training 
  • Costs related to the common platform pleje.net 

Process

Telemedical wound assessment consists of a digital wound record as well as organizational changes in relation to collaboration across sectors and workflows.

In the project National Distribution of Telemedical Wound Assessment, it was desired to implement telemedical wound assessment throughout the country in order to streamline, release time and improve the quality of wound treatment. It does not change the treatment itself, but in the way it is delivered, as well as work procedures and the cooperation between municipalities and hospitals around the wound treatment and care of wounds. It is therefore not a substitute for another treatment.

Communication

All communication is being handled through pleje.net, where both patient and health staff can follow the process.

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More about effects

Almost every patient express satisfaction and security taking part in the solution and they feel more involved in their own treatment and that they have to take more responsibility.

The benefits of the solution: 

  • Shorter healing time 
  • Less transport of fragile patients, including savings on patient transport 
  • Less time spent by the doctor in the hospitals who is doing short telemedicine consultations and initially only seeing patients with the most complicated wounds in the outpatient clinic. 
  • Great patient satisfaction. 
  • Increased competencies of the municipal nurse through the more direct collaboration with regional wound nurses and doctors. 

The results show that the telemedical wound assessment increased costs for investment and operation of the telemedicine equipment as well as home care costs, but these additional costs are more than compensated by reduced consumption of hospitalizations and outpatient visits to hospitals, but the reduction in costs is not statistically significant.

Learnings

  • The technical part of telemedical wound assessment consists of a digital wound journal, www.pleje.net, which is used as a documentation tool and for telemedical communication between healthcare professionals within and across sectors, and with the possibility of communication between the citizen/patient and the healthcare staff. In addition to the technical part, this is largely an organizational project, as the solution requires changes in work procedures and roles across sectors as well as competence development of professional staff including training of wound nurses.  
  • It is recommended to have focus on education and skill development among the health professionals.  
  • The platform for data collection and management should be further developed as it can be tricky to use the generated data.  

More testimonials

“As a municipal nurse I felt a little alone being in the patients own home. It could be difficult to convince the patient that a change in their treatment was necessary. Today, some of the country’s best doctors and wound nurses are just a click away – it almost feels like they are there with me. For example, when I treated Ole I constantly got feedback from the wound centre at the hospital.”
– Bente Larsen, municipal wound nurse. 

“We have become a lot closer in the municipalities and hospitals. We have started to use telemedical wound assessment. I now often teach the municipal nurses. We also do a lot to create a learning environment when we write to the wound nurses – so they become more and more competent.”
– Else Godsk Vestergaard, wound nurse at a wound center. 

The solution started as a project in just one region and was later decided to upscale to a national level, the solution is therefore tested for upscaling. As of now the solution is though not accessible for upscaling across borders as patients will need to be connected to a hospital within their own region.  

www.medcom.dk  

Tanja Gerner Jusslin  
Forskerparken 10  
DK-5230 Odense M 

Telemedicinsk Sårvurdering (Telemedical wound assessment) 

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