Wound care
Over the past few years, tech developers and clinicians have been working on a spectrum of digital platforms designed to make healthcare more accurate, objective and contactless. It’s this last condition – the ability to move health services out of the clinic and into the virtual realm – that has changed the rules of the telemedicine game in the wake of the pandemic. As Dr Ammar Al Rubaiay, foot and ankle surgeon at North Shore Foot & Ankle Associates in Chicago, explains: “Covid-19 has had a significant impact on essential wound care services. Most patients with chronic wounds have underlying medical conditions that put them in the very high-risk category for severe Covid complications, so there is general hesitancy in going to frequent doctor visits, which are normally required in wound care patients.” In other words, wound care patients suffering from chronic conditions are among those most at risk of catching Covid-19 – but also those most in need of clinical attention. Legitimate fears, not to mention government limitations, have kept these patients at home, when frequent visits were, quite literally, what the doctor was ordering.
Touching base without touching the patient
Dr Alisha Oropallo, medical director of the Comprehensive Wound Healing Center and Hyperbarics at Northwell Health, also stresses the importance of wound care consultations. “About 20% of our patients come back from the hospital to the wound centre,” she says. “But what we found was that, of 500 patients that we analysed, those that actually came to the wound centre reduced their readmission rate and mortality from 40% to 9%. So, we made strong impact at reducing mortality if we just were able to touch base with the patient afterwards.”
Just touching base is precisely what these telemedicine solutions allow for. Throughout the pandemic, clinicians like Oropallo and Al Rubaiay were able to monitor their patients remotely. As Al Rubaiay recalls, “I had a number of cases where patients were afraid to present for in-person evaluation and were concerned about the condition of their wound.” Using video platforms such as Doximity, Zoom, FaceTime and Zocdoc, Al Rubaiay could “set up a telemedicine visit and, through that, […] recognise soft tissue infections in patients” and then “send [them] antibiotics and advise [them] to go to the hospital for proper management of the condition in severe cases”.
Meanwhile, over at Northwell, New York’s largest healthcare provider, Oropallo and her team were able to fit in same-day telemedicine appointments for critical patients on three-week hospital waiting lists. As Oropallo comments, “I think that
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[telehealth] could change the way that we practice medicine. I think it already has. For the better.” Similar examples have been widespread over the past 12 months across all aspects of medical care, as doctors have seen increasing numbers of patients via remote video conferencing apps. But when it comes to wound care, such measures are often insufficient on their own. “There are still a lot of limitations to doing something over the phone versus clinically evaluating somebody,” Oropallo admits. “Mainly being able to touch them. When we talk to the patients, we ask them to do the physical examination that we would normally do. For example: ‘Please touch there. Do you have pain there? Is there swelling? Does it feel hard?’ So, we’re asking the patients to do the physical examination that we would normally do without them even noticing.” Al Rubaiay, too, emphasises the limits of these technologies, noting that “telemedicine is best used as an adjunct tool to [supplement] the standard practice of seeing patients in the office. But a proper physical exam cannot be replaced with a telehealth visit”.
Telehealth platforms have helped clinicians to contact wound patients who have difficulties attending an in-person evaluation.
“Covid-19 has had a significant impact on essential wound care services. Most patients with chronic wounds have underlying medical conditions that put them in the very high-risk category for severe Covid complications.”
Dr Ammar Al Rubaiay, North Shore Foot & Ankle Associates
Yet, while in-person consultations remain essential in some cases, telemedicine technologies are continually adapting to suit a more virtual world, offering ever more advanced possibilities for remote healthcare. One such example is Tissue Analytics, a
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