Brookhaven Memorial Hospital Medical Center is a 321-bed acute care, voluntary, not-for-profit community hospital in New York. Established in 1956, Brookhaven recently organised its Center for Wound Care and Hyperbaric Medicine to reflect the needs of the community and the increasing prevalence of diabetic wounds of the lower extremities, pressure ulcers, ulcerations related to advanced vascular disease (both arterial and venous), surgical wounds and soft tissue radionecrosis injuries.
The wound care centre has been operating since February of 2006. Since then, centre clinicians have healed 89.5% of all presenting wounds, while performing over 4,000 procedures. More than 60 patients have benefited from hyperbaric oxygen therapy as an adjunctive therapy to wound care, while more than 2,000 treatments have been performed.
Wound care is an emerging medical discipline, so it is important that experts in the field and wound care students are able to communicate with one another using the latest technology. The most common IT applications for educating and training clinicians are PowerPoint presentations, digital photography, video presentations, web-based conferences and databases.
The wound care centre’s activities are based on a medical model, and it is staffed by at least one physician at all times. The centre has three medical directors who, together, lead the clinical team. The full-time medical director, Dr Charles Dennis (vascular surgeon), dedicates all of his professional time to the centre. Dr Robert Prichep (vascular surgeon) and Dr Edward Kormylo (podiatric surgeon) are co-medical directors. They work in the centre and also manage private practices. The physicians at the wound care centre offer more than 75 years of clinical expertise to the centre’s patients.
Before beginning work at the centre, physicians attend the only accredited problem-wound management and hyperbaric medicine course in the US, organised by Diversified Clinical Services, to add to their specialised medical knowledge and wealth of experience.
The course provides a number of different learning environments for clinicians, including facilities for lecturing, testing and practicums, and it incorporates a wound care centre site visit. Most of the course consists of professional lecturing and testing, much of which makes use of PowerPoint presentations, digital photographs and video presentations. The PowerPoint presentations provide a platform for lecturers to clearly outline the major concepts in wound care they cover, while technical instruction can be recorded and played back through the PowerPoint programme.
Digital photography is integrated into lectures to illustrate wound healing outcomes, aetiological signs and symptoms, procedural techniques, rare wound cases and anatomical structures and dysfunctions. Practicums are an effective way of providing hands-on education in bioengineered tissues, negative pressure wound therapy, total contact casting, compression bandaging and sharp debridement.
Selected practicums are accompanied by video presentations, which provide additional technical information. The course is offered to all wound care staff: nurses, hyperbaric technicians and administrative personnel alike.
The wound centre’s clinicians are continually being updated and supported clinically by nationally recognised wound care experts, such as Dr Robert Warriner, Diversified Clinical Services’ executive vice-president of medical affairs. Recently, Dr Warriner, conducted a series of web-based conferences for the wound centre’s clinical staff, which covered key therapeutic objective, the essentials of wound evaluation and management, the four most common wound diagnoses, and hyperbaric oxygen treatment.
Web-based conferencing offers Dr Warriner a number of facilities that were previously unavailable. The presentation was organised in a screen-by-screen slide-presentation format. As he reviewed the slides, Dr Warriner lectured using a telephone conference call facility, while wound centre physicians were invited to ask questions in real time. The lecture proved to be an interactive and fluid presentation that allowed the audience and presenter to fully engage.
The centre has initiated a plan to educate community clinicians, nurses, and the patients and families it serves. Physician-to-physician mentoring and education is conducted on both a large scale and on an interpersonal level. Recently, Dr Dennis spoke on diabetic foot ulcers for the medical centre’s Clinical Problems in Medicine lecture series. This lecture series was supported by medical staff to increase physician interaction and communication on specialised acute and chronic care. Dr Dennis prepared a PowerPoint presentation that delineated:
- The rise in diabetes-related amputations (due to ulcerations and infection) and its associated mortality rates post-amputation
- Diabetic ulcer prevention opportunities for primary care physicians
- The factors that contribute to the development of diabetic ulcers and the wound care techniques that can be used to manage the resulting infection
- The vascular needs of diabetes-related wounds and the use of adjunctive hyperbaric oxygen therapy
- Physician-to-physician communication takes place through follow-up letters.
Physicians referring patients to the centre receive letters that include pictures of the patient’s wounds as well as information on the progress of the wounds, the measurements of the wounds and the plan of care. They also receive a note from the centre physician caring for their patient. Both the large-scale and interpersonal interactions allow the wound centre’s physicians to partner with community physicians in building a reservoir of wound care knowledge that is available to the wider medical community.
Community outreach is accomplished using PowerPoint presentations. The programme director organises events where the centre’s physicians speak. Centre physicians have lectured at public libraries, club and association meetings and other clinical community meetings.
The wound centre has obtained access to the web-based Woundstar database. This proprietary wound care database assists the centre’s clinicians in effectively managing patient care. Patient wound care information – such as the date, wound measurements, diagnosis, procedure performed and patient education – is entered into the database daily.
Woundstar enables the centre’s clinicians to produce reports, benchmark patient progress, capture the patient diagnoses and provide a history of the patient care provided by the centre. The wound healing reports can identify wound healing outliers (those that fall outside a 14-week period), calculate average time to healing, work out the percentage of wounds that heal within 14 weeks and generate a list of potential patients suitable for hyperbaric oxygen therapy.
WOUND CARE TECHNOLOGY
Wound care is continuing to emerge as a medical discipline, and teachers and students of wound healing alike are benefiting from a variety of technologically advanced communication applications and tools that increase the effectiveness of their exchanges. The wound care clinicians at the wound care centre at Brookhaven continue to use PowerPoint, digital photographs, web-based conferencing and database tracking to teach other clinicians in the community, increase their wound care knowledge, track patient progress and cooperatively discuss particularly difficult cases with their colleagues.
The role and importance of technology continues to grow in the healthcare field. Many medical disciplines have benefited greatly from technological advances, and the wound care discipline is no exception.