Introduction
The field of wound care is experiencing a significant transformation, with a marked shift from acute to post-acute care settings. This transition is driven by the need for more specialized and continuous care for patients with severe wounds, which can include chronic leg ulcers, pressure ulcers, diabetic foot ulcers, and post-surgical wounds. The move towards post-acute care aims to enhance the quality of care, improve patient outcomes, and reduce healthcare costs.
What are the wound care goals
Depending on the patient’s situation, the three goals of wound healing, maintenance, and care are comfort. If the goal is wound healing, treatment should focus on wound granulation and eventual closure. However, if the wound is unlikely to heal (for example, an elderly patient with arterial wounds who is too frail for a vascular intervention), the goal is to keep the wound clean, stable, and free of infection For patients receiving end-of-life care, comfort is the goal. Treatment includes dressings that are changed less frequently, cause less pain, adequately absorb drainage, and control foul odor. Keep in mind that goals may overlap and evolve, so the wound care plan should be modified as necessary
Reduce risks
Pressure injuries, a common issue in wound care management, can pose a high risk to your business, whether you provide skilled nursing care to residents, home health care to clients, or another combination of post-acute care services. According to the Agency for Healthcare Research and Quality, about 2.5 million people in the U.S. develop pressure injuries each year, and more than 60,000 patients die each year due to the condition.
Pressure injuries cost $9.1 billion to $11.6 billion annually, with individual patient care ranging from $20,900 to $151,700 per injury. More than 17,000 lawsuits related to pressure ulcers are filed every year. Comprehensive staff education and training can provide your organization with a powerful instrument to refine wound care management and promote greater financial stability.
Challenges in Wound Care
The effectiveness of wound care is anchored by four parameters:
- Governmental regulation (and reimbursement)
- Insurance coverage and payments for products, services, and treatments
- Availability (or lack thereof) of clinical expertise and resources in wound care
- Ability of the patient (or their health representative) to advocate for benefits
Wound treatment formularies also vary among health care settings. Patients discharged from one setting with one type of wound product may not find the same wound product available in the next setting. From setting to setting there also may be varying opinions on the healability of a wound and the appropriate approach to wound treatment.
Depending on the wound expertise of the clinical team, they may or may not be able to navigate between comparable products that produce the same positive wound outcome. Facility resources such as staffing and the ability to keep a well-stocked central supply also influence the approach to wound treatment from setting to setting.
Responsible Person for wound care
Clinicians need to assess whether the patient is functionally and cognitively able to perform wound care. If not, other options include a home health nurse or a family member or friend. If the patient lives in a remote area and wound care will be done by a family member with only periodic visits by a home health nurse, the in-patient nurse needs to assess the caregiver’s ability to complete care tasks and provide education. The teachback method allows caregivers to demonstrate what they’ve been taught so the home health nurse can assess comprehension and ability.
If the patient is being discharged to a setting other than the home, the facility must demonstrate the availability of clinicians who have the knowledge and skills to manage the prescribed wound therapy.
Factors Driving the Shift in Wound Care
The shift in wound care practices is influenced by several key factors, including advancements in technology, patient-centered approaches, and healthcare system changes. Here are some of the major drivers:
1. Technological Innovations
- Development of regenerative medicine techniques, such as skin substitutes and stem cell therapies, is transforming wound care.
- Emerging technologies like chemical debridement agents and advanced foam dressings are improving healing outcomes.
2. Patient-Centered Care
- A growing emphasis on shared decision-making and patient involvement in wound care planning.
- Patients increasingly prefer treatments that are less painful, faster, and tailored to their individual needs.
3. Focus on Health Equity
- Efforts to address healthcare disparities are ensuring more equitable access to wound care for diverse populations.
- Advances in diagnostic tools are helping to identify chronic wounds in patients with varying skin tones.
4. Regulatory and Reimbursement Changes
- Evolving regulatory requirements and reimbursement policies are encouraging best practices and innovation in wound care.
- Patient-reported outcomes (PROs) are becoming a critical component in evaluating treatment effectiveness.
5. Social Determinants of Health
- Addressing these determinants is essential for improving patient experiences and recovery.
- Factors like access to care, education, and socioeconomic status are increasingly recognized as influencing wound care outcomes.
Challenges in the Transition
1.Resource Limitations
One of the primary challenges faced in the shift to post-acute wound care is the availability of resources. Effective wound care requires skilled professionals, advanced equipment, and adequate facilities. Ensuring that post-acute care settings are equipped to handle severe wound cases can be challenging, particularly in rural or underserved areas.
2.Training and Education
Another challenge is the need for specialized training and education for healthcare providers in post-acute settings. Wound care is a complex field that requires a deep understanding of wound biology, assessment techniques, and treatment modalities. Ongoing education and training programs are essential to equip providers with the knowledge and skills needed to deliver high-quality wound care.
3.Coordination of Care
Coordinating care among different providers and settings can be challenging. Effective wound care often involves a multidisciplinary approach, requiring collaboration between various healthcare professionals. Seamless communication and coordination are critical to ensuring that patients receive comprehensive and consistent care throughout their recovery journey.
4.Data Privacy and Security
As with any aspect of healthcare, data privacy and security are paramount. The sharing of patient information across different providers and settings must be carefully managed to protect patient privacy and comply with regulations such as the Health Insurance Portability and Accountability Act (HIPAA). Ensuring secure and efficient data exchange is essential for effective wound care management.
The Role of Telemedicine
Telemedicine is playing an increasingly important role in the shift to post-acute wound care. Virtual consultations and remote monitoring allow wound care specialists to assess and manage patients’ wounds without the need for in-person visits. Telemedicine can enhance access to specialist care, particularly for patients in remote or underserved areas, and facilitate timely interventions that can prevent complications.
Transition of Care for Chronic Wounds- A Case Manager Perspective
Effective transitions of care for chronic wound patients are vital to ensure seamless continuity between hospital and community-based settings. By aligning acute care providers with home-based teams, clinicians can create individualized care plans emphasizing consistent wound management, patient education and timely follow-ups. Standardized communication protocols and digital tools, like shared electronic health records, enhance collaboration across disciplines, ensuring patients receive comprehensive, uninterrupted care tailored to their needs.
Community-based settings for chronic wound care, as highlighted in “Post-Acute Transitional Services: Safety in Home-Based Care Programs,” are pivotal in ensuring patient safety and improving outcomes. These settings include services provided by home health agencies and home-based primary care programs tailored to meet the needs of patients transitioning from hospital or skilled nursing facilities to home environments.
Home Health Agencies provide on-the-ground wound care, patient education and caregiver training to promote healing and prevent complications. However, they face challenges such as varying quality of care, inconsistent adherence to evidence-based practices and challenges of rehospitalization due to factors like insufficient caregiver skills or simply fewer community-based settings that will accept chronic and complex wounds such as stage 3 or 4 pressure injuries.
REFERENCES
- Gould L, Herman I. Out of the Darkness and Into the Light: Confronting the Global Challenges in Wound Education. Int Wound J. 2025 Jan;22(1):e70178. doi: 10.1111/iwj.70178. Erratum in: Int Wound J. 2025 Feb;22(2):e70195. doi: 10.1111/iwj.70195. PMID: 39799981; PMCID: PMC11725353.
- Krapfl LA, Peirce BF. General principles of wound management: Goal setting and systemic support. In: Doughty DB, McNichol LL, eds. Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016; 69-79.
- Dreyer T. Care transitions: Best practices and evidence-based programs. Home Healthc Nurse. 2014;32(5):309-16.
- Ebot J. Managing Complex Wounds in Skilled Nursing Facilities (SNFs). Cureus. 2023 Oct 24;15(10):e47581. doi: 10.7759/cureus.47581. PMID: 38021971; PMCID: PMC10666797.
- Kirkland-Kyhn, H., Howell, M., Senestraro, J., & Walsh, S. (2021). Leveraging technology to improve wound care delivery and care transitions. Nursing Management (Springhouse), 52(11), 24-28. https://doi.org/10.1097/01.NUMA.0000795592.38063.7c.
- McElroy, V., Ordona, R. B., & Bakerjian, D. (2022). Postacute transitional services: Safety in home-based care programs. PSNet [Internet]. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. https://psnet.ahrq.gov/.
- Ordona, R. B. (2024). Transition of care challenges and opportunities for chronic wounds. Nursing Clinics of North America. https://doi.org/10.1016/j.cnur.2024.07.014.
- The Wound Provider Checklist — A Guide to Assist in Quality PALTC Wound CareBolhack, Scott et al.Caring for the Ages, Volume 24, Issue 2, 17
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