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Chen et al. Clinical pathway for an efficient wound care center

established, wound inpatients were referred to different
specialized departments such as dermatology, surgery,
and internal medicine, where wound management
care was limited to that department’s particular
function. And the wound consultant by plastic surgeon
usually took a few days even in urgent cases. In wound
management pathway, without an uncertain waiting
period, senior consultants can approach patients in
person with professional wound assessments and
perform immediate debridement on-site as needed
[Figure 1]. The therapeutic process lags and can
be delayed because the chronic wound may need
a series of debridement and regular follow-up. The
coordinator (nursing staff) also assisted the consultant
in scheduling follow-up appointments at the center as
Figure 1: The conceptual framework for wound management clinically needed. The wound care center provides not
service contains three steps, including patient entry/on-site only one-time wound care, but also a complete program
debridement, wound re-evaluation, and individual wound bed of care including further education and prevention for
preparation. If the ambulation is possible, we will visit the patient
at WCC and do the wound management service including patients and families.
debridement or wound care advice. If not, we will go to bed side for
visit. OR: operating room; WCC: wound care center After being referred and completing the first visit and
debridement, the patients proceeded to step two,
chronic wounds through the stages of healing, reduce
infections or complications, and prevent future chronic wound re-evaluation, including neurologic evaluation,
wounds as well as restore the functional activities vascular evaluation (e.g. Ankle-Brachial Index), and
of daily life. Although the benefits of wound care the TIME concept (Tissue, Infection/Inflammation,
[4]
service and multidisciplinary teams care have been Moisture imbalance and Edge of wound). Wound
well discussed, [1-3] there is a practicing gap about the size is measured by the longest length and width of
establishment of an efficient referral system. Patients the wound. All individual patient wound profiles are
are often confused regarding whom to see for wound organized into our data bank, which can be analyzed
care, and simply receive wound treatment by the for wound care efficacy and follow-up.
individual specialists they visit, in which the specialists
may not actively track wounds unless they are consulted The third step includes setting up the individual wound
again. And healthcare providers (plastic specialists, care plan based on the results of wound re-evaluation
dermal specialists, general practitioners, nurses) in step two. Emphasis is placed on the importance of
also found it difficult to manage wound care across wound bed preparation (using TIME), early referral
disparate levels of departments. Furthermore, a lack between members of the multidisciplinary team, such
of organization and specific space may postpone the as vascular team, hyperbaric oxygenation therapy,
accurate screening and debridement on-site and on- further education and prevention. Offloading must
time. Therefore, the establishment of clinical pathway therefore be addressed in a timely manner.
for wound management service/pathway is crucial.
THE EFFICIENT REFERRAL SYSTEM FOR
WOUND MANAGEMENT PATHWAY WOUND CARE CENTER
The wound management pathway consists of three Multiple studies have supported the efficacy of protocol-
steps. The first step is patient entry and onsite immediate based treatment for pressure ulcers, venous stasis ulcers,
wound debridement, which indicates the patient and diabetic foot ulcers. [5-7] Edwards et al. confirmed
[8]
referral process where wound center clients were that the implementation of evidence-based protocols
referred from outpatient clinics and inward consultants. for wound assessment and treatment was significantly
The wound care service is initiated once the physician related to improve healing outcomes. The principle of
from any other departments considered wound care wound care protocol is easy to comprehend, but the
service necessary. The patient is scheduled for a visit execution of the clinical efficient wound management
to the wound care center by the coordinator, and the service is complicated and needs a standardized and
appointed doctor can meet the patient and family on well-integrated multidisciplinary team with specific
the arranged day to discuss the wound condition with capacity. The main reason for difficulty in wound care
them. Before the wound management pathway was is the poor referral system, which may be attributed to
376 Plastic and Aesthetic Research ¦ Volume 3 ¦ December 20, 2016