Introduction

Chronic and complex wounds present a formidable challenge in health care. Nonhealing wounds impact approximately 1% of the world's population yet account for more than 2% to 4% of health care expenses. Wounds that require additional clinical efforts often include those that are chronic and resistant to therapy, those with increased risk, and those that reduce the patient's quality of life.¹ Although many aspects of chronic wound care have been studied, one that stands out in terms of its potential to impact wound healing positively is the use of a multidisciplinary team. Multidisciplinary approaches to wound care in the primary health sector and in hospitals have demonstrated a reduction in home visits and a decrease in the range of products used.¹

Why Use a Multidisciplinary Team?

Using a multidisciplinary approach to wound management has been extensively studied, and the results overwhelmingly support the positive impact this can have on wound healing. Examples include:

• Multidisciplinary teams reduced major amputations in patients with diabetic foot ulcers by 94%. These teams consistently addressed glycemic control, local wound management, vascular disease, and infection to avoid amputation.²
• Collaborative multidisciplinary teams combined with enhanced education can reduce healing times, lower recurrence rates, and decrease the rate at which health services are accessed, thereby leading to a reduction in primary health costs.³
• Multidisciplinary teams can reduce postoperative infection rates.⁴

It is clear that a multidisciplinary approach is highly beneficial both to the patient and to the overall health care system.⁵

Who Makes up a Multidisciplinary Wound Care Team?

Wound care is a common concern for many disciplines, and this is why a multidisciplinary approach works.⁴ It incorporates all aspects of wound management into a comprehensive treatment plan when a team is designed thoughtfully to include all clinicians who can bring insight to the wound care plan. Team composition may vary depending on the type of wound, but could it include individuals from a broad range of medical disciplines, including but not limited to:

Surgeons

Specialist surgeons can have vascular, orthopedic, gastrointestinal, and plastic surgery as medical specialties. Surgeons with these medical specialties that traditionally handle wound healing problems may be included to contribute in daily evaluations and specialty consults.¹

Nurses

Nurses often handle dressing changes and can alert the team to other clinical concerns. Nursing staff may include all clinical and research nurses with different levels of specialization.¹ There are various wound care certifications available to wound care professionals that help to inform an interdisciplinary approach. Nurses with these certifications provide specific expertise, ranging from knowledge of pressure injury and ostomy care to the use of hyperbaric oxygen therapy. Several of these certifications are listed here, although this list is not complete:^6,7

• Wound, Ostomy, and Continence Nurse (WOCN)
• Certified Wound Care Nurse (CWCN)
• Certified Wound Care Specialist (CWS)
• Wound Care Certified (WCC)
• Certified Wound Care Nurse (CWCN)
• Certified Wound Care Associate (CWCA)
• Ostomy Management Specialist (OMS)
• Certified Hyperbaric Registered Nurse (CHRN)
• Nutritional Wound Care Certified (NWCC)⁸

Podiatrists

If the wound is a lower extremity wound, a podiatrist should be included on the team.¹ These professionals can collaborate with the team to recommend targeted management strategies, such as offloading, pressure relief, debridement, dressing selection, and surgical intervention when necessary.⁹

Physical therapists

Although all physical therapists have some familiarity with wound care, clinicians putting together a multidisciplinary team should seek out a physical therapist whose practice focuses on wound care in some capacity. Patients who are weak or have trouble ambulating may have wounds that worsen because of lack of strength. Physical therapists can create an exercise plan that strengthens the patient. It has been studied that an increase in a patient’s strength can increase the speed of healing in some cases. Physical therapists may also be able to assist with pressure relief materials, sitting posture, compression therapy, and rehabilitation.^1,10.11

Ancillary staff

Additional clinical staff, such as administrative assistants and technicians, may also support wound management in a variety of ways.¹

Primary care physicians

Multidisciplinary teams have been found to function better when they have a leader and clear referral pathways. The primary care physician may serve in this role to coordinate care across various medical specialties.²

Dietitians

Nutrition is an often overlooked but important part of wound care. Specific macronutrients and micronutrients such as protein and zinc are essential for proliferation. A dietitian can create meal plans that account for any deficiencies that may be affecting wound healing. Additional specialists may be required to address unique aspects of wound management.

These specialists often come from endocrinology, infectious diseases, general medicine, physical medicine and rehabilitation, peripheral vascular surgery, orthopedic surgery, podiatry, and plastic surgery. Additional allied health professionals can draw in even broader discipline involvement, including casting, diabetes education, medical quality, quality of nutrition, occupational therapy, orthotics, pharmacy, physical therapy, prosthetics, and social work.² Family members or support individuals who provide wound care outside of a clinical setting are often essential to wound management as well.

Conclusion

The reality is that creating a one-model-fits-all approach to wound management is unrealistic. Care plans may be impacted by resource availability, access to relevant expertise, remuneration provisions, and patient populations. An individualistic model that prioritizes the patient’s needs is essential for successful wound management. Often, there is a clinician in the role of patient advocate who is able to bring together the patient’s perceived needs, treatment aims, and appropriate health care services into a management and care plan. This strategy can be highly successful in coordinating all of the members of the multidisciplinary team.¹²

References

1. Gottrup F, Holstein P, Jorgenson B, et al. A new concept of a multidisciplinary wound healing center and a national expert function of wound healing. JAMA Surg. 2001;136(7):765-772.
2. Musuuza J, Sutherland BL, Kurter S, et al. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg. 2020;71(4):1433-1446.
3. Norman RE, Gibb M, Dyer A, et al. Improved wound management at lower cost: a sensible goal for Australia. Int Wound J. 2015;13(3):303-316.
4. Boga SM. Nursing practices in the prevention of post-operative wound infection in accordance with evidence-based approach. Int J Caring Sci. 2019;12(2):1228-1235.
5. Falcone M, De Angelis B, Pea F, et al. Challenges in the management of chronic wound infections. J Glob Antimicrob Resist. 2021;26:140-147.
6. The value of a WOC nurse. Wound, Ostomy, and Continence Nurses (WOCN) Society. 2022. Accessed July 21, 2022. https://www.wocn.org/healthcare-providers/the-value-of-a-woc-nurse
7. Tozier D. Different wound care certifications for nurses and what they mean. Wound Care Advantage. 2022. Accessed July 21, 2022. https://thewca.com/2021/06/21/different-wound-care-certifications-for-nurses-and-what-they-mean
8. Nutrition wound care certified certification. National Alliance of Wound Care and Ostomy. 2020 Accessed July 22, 2022. https://www.nawccb.org/nutrition-wound-care-certification
9. Armstrong DG, Rogers LC, Andros G, et al. Toe and flow: essential components and structure of the amputation prevention team. J Vasc Surg. 2010;46:465-470. doi:10.1016/j.jvs.2010.06.004
10. Azola G. Wound specialist | chronic wounds | diabetic ulcers. CutisCare. 2022. Accessed July 21, 2022. https://cutiscareusa.com/what-are-the-advantages-of-a-wound-specialist
11. Physical therapy guide to wounds and wound care. ChoosePT. 2021. Accessed July 21, 2022. https://www.choosept.com/guide/physical-therapy-guide-wounds-wound-care
12. Moore Z, Butcher G, Corbett LQ, et al. Exploring the concept of a team approach to wound care: managing wounds as a team. J Wound Care. 2014;23(suppl 5b):S1-S38.