Transcript

What is mobile wound care?

Haresh Kane, MD, CWSP:

Mobile Wound Care is the concept of bringing the wound care center to the patient's bedside, wherever that patient may be located. It's a concept that was started in the early 2000s with this inherent need to provide bedside wound care, high quality wound care, to patients who were in essence locked in to either their nursing homes or assisted living facility or retirement community or just didn’t have the means or the ability to transport themselves to a wound care center.

So, fast forward to 2024, this is an extremely successful way of delivering care to patients. It's extremely cost effective, which definitely Rob can attest to as a former director of nursing. It's a cost that in the past was a huge burden to especially nursing homes, which is the focus of our practice. So, the ability for wound care physicians and clinicians, such as myself, to go see patients in a SNF setting, a skilled nursing facility, or a post-acute care facility is a real boon to those facilities and to those patients.

Mobile wound care services like Kane Wound Care, can provide basically any service, if not more, that you would find in a typical wound care center in the United States. Really, the only line of service that we currently cannot provide to a patient located out in the community would be hyperbaric oxygen treatment for the simple reason that it's extremely difficult and prohibitive to transport hyperbaric oxygen chambers to a patient or into the community. Certainly not something that's prevalent here on the northeast coast. There are some pockets in the United States that have tried to do that. Again, it's not something that's easy, to take a hyperbaric oxygen technology to the patient, but other than that, whether it's the debriding a wound, whether it's providing an advanced technological modality, such as low frequency, non-contact ultrasound energy, whether it's conducting biofilm analysis, whether it's conducting near-infrared spectroscopy, these are all modalities that we can provide as a mobile wound care service to our patients out in the community.

We can also apply CTPs, cellular and tissue-based products to patients that warrant them for chronic non-healing wounds. Again, that's something that we can easily provide to patients from a mobile perspective. I'd like to think our services are superior in many ways to a wound care center because we get to know our patients intimately well because we see them on a weekly basis. And we forge a very strong relationship with all of our partners, customers, and patients that we service. I do see this mobile wound care movement growing exponentially over the next few years and decades to come.

How can mobile devices be used to measure and track patient outcomes in wound care?

Robert Calalang, BSN, RN, CWS:

The mobile devices we utilize to measure and improve patient outcomes are absolutely extraordinary and they really allow us to elevate the standards of care. We currently have 3 different types of devices that give us 3 separate outlooks in the wound care world. The one device can actually initiate wound healing with low frequency, non-contact, and pain-free ultrasound therapy, which promotes angiogenesis and we've witnessed tremendous improvements from it.

The second device enhances our ability to actually visualize biofilm, which is bacteria, that can't be seen without the use of this technology, and it really assists us with targeted debridement in specific areas of where the bacteria is, and it really gives us insight into the type of bacteria we may see in a wound.

The third device quantifies tissue oxygenation of the wound bed, which takes us into the realm of truly understanding the overall vascular circulation, which is now absolutely fascinating. As we discuss these 3 devices, these game-changing advantages help us understand the true impact of utilizing the devices on a consistent basis that allows us to follow important trends. With all these mobile devices we are now able to track patient outcomes and promote true measurable healing rates.

What key performance indicators or metrics would you prioritize to assess the effectiveness of mobile-enabled wound care initiatives?

Robert Calalang, BSN, RN, CWS:

There are a couple indicators and metrics that we're always looking at when we assess the status of a wound. The 4 main categories are if the wound is healed, improving, stable, or deteriorating. Now, on top of that, there are many factors that would determine these statuses, such as wound etiologies. Is it a pressure injury? Is it a vascular wound? Is it a diabetic foot ulcer? Is it a trauma wound? That's something that we would have to look into.

Next would be wound size. Did it get larger? Did it get smaller? Or is it the same size? Next would be staging. If it's a pressure injury, so is it a stage I, stage II, stage III, stage IV, potentially an unstageable, or a deep tissue injury also known as DTI.

Next would be percentages of tissue types. So, epithelialization tissue, granulation tissue, eschar or slough, how much is in the wound? It would be really indicative depending on what type of tissue type it is in regards to what the wound is looking like.

So now, is there an odor? Can it be a foul-smelling odor? Absolutely. Can there be no odor? Yes. But also, is it a fruity odor which may be indicative of a certain bacteria, something to look into?

The amount of drainage, is it scant, small, moderate, or large? Of course, we'd be more concerned if there was large compared to scant amount. Something that goes alongside that is what type of the drainage is it? Is it cirrus or is it serosanguineous? Is it sanguineous or is it purulent? These drainages can be indicative of something that may be brewing. So, something we'll look into as well. And most importantly overall description of the wound.

Now this documentation is very important for the quality measures within our facilities, especially if they have a new or worsening stage 2, stage 3, or stage 4, or if they are high risk for pressure injuries that were not present on admission and unfortunately facility acquired. Since we as a group are firm believers in continuum of care, we really look at the trends on a weekly basis of how the wound has progressed and we adjust our treatment plan accordingly to achieve the best possible outcomes.

Haresh Kane, MD, CWSP:

I'd also like to add to Robert's excellent answer the quality of the granulation tissue, which is also something that's interesting for practice. One of the LCD guidelines that's listed in CMS's wound care is: is the granulation improving? And we also, we take that into 2 kind of categories. Is the quantity of granulation tissue improving? Are we getting more granulation tissue in the wound bed as the wound is responding to our appropriate treatments? And is the quality of the granulation tissue improved? Is that angiogenesis really coming to fruition? And I think it's important for us to really recognize that and understand that. And that's where some of the technologies that Rob was referring to helps us quantify oxyhemoglobin and StO2 of the tissues. In essence, we're getting a tissue oximetry, and we've been getting a lot of interesting data from our wounds showing an improved oxygenation level after we debride a wound, after maybe we provide non-contact, low-frequency ultrasound energy to the wound. We're seeing in many cases an uptick above 10 % in oxygen saturation for that particular tissue in that wound area.

That's really exciting because now we're able to really track how our treatments are affecting the wound and we're finding the answer is that the improvements are very robust and very positive. And that's something that's very interesting for us on the clinical leadership side of things and within our practice. How can we utilize this technology to guide our treatments and to make our treatments more efficient in a sense. The quality of the granulation tissue, I think, is extremely important to discuss. And it should be part of any good mobile wound care practice strategy when they're approaching their wounds.

How can mobile devices facilitate communication and collaboration among health care professionals involved in wound patient care?

Robert Calalang, BSN, RN, CWS:

Some of the key factors when we're bringing these mobile devices into facilities is that it really encourages the staff to expand their knowledge and it truly shows the intellectual curiosity they possess. So for example, when I first walked into a building, they're like, "Wow, this is amazing. What does it do? Can you show us? When do we start?" It really entices them to collaborate with us on wound rounds to see what information the devices provide during the assessment.

And not only that, it challenges them to think 3-dimensionally to understand the overall status of the wound. Now, not only is there an enhancement of communication with the nursing department, but it also promotes a collaborative interdisciplinary approach that involves the medical directors of the facilities, the primary physicians that involves our mutual patients, surgeons that are asking us to follow their surgical patients and the surgical sites, rehabilitation teams where we work with to get offloading measures such as a wedge pillow, a wheelchair cushion, or an offloading heel boot. And of course, last, but not least, the dietitians where we all know nutrition is very important. Maybe we want to check the vitamin D levels or the albumin levels and ensure that the protein intake is adequate. As you can see, all these departments try to put all the pieces of the puzzle together to create an individualized, patient-centered plan of care.

Haresh Kane, MD, CWSP:

That’s an excellent answer, Rob, and I'm going to piggyback again on that. Anecdotally, what we're seeing in the post-acute facilities that we service in New Jersey and Pennsylvania and in New York is a lot of the clinical staff, the ancillary clinical staff, or even the attendants on the case, are actually coming to us and asking, before we even get a chance to evaluate the patient for the wound, "Hey, what's the biofilm analysis for that wound? Can you guys check the biofilm for me? And can you guys give us an indication with the bacterial burden is in the wound? How about using a low-frequency ultrasound energy on this wound to enhance the debridement for that particular wound bed with all the necrotic tissue?” And we suspect as we roll out other cool pieces of technology, lack of a better description, into the post-acute world where we service, we feel people are going to start asking us questions about tissue oximetry measurements and near-infrared spectroscopy analysis.

We're definitely introducing a new medical terminology within the wound care space, which has historically been pretty stale over the last 2 decades. And this is work that Rob and I and the rest of us our team are extremely proud of because we are pushing the bounds of innovation. We are the leaders in our particular space. And I think Rob hit it on the head when he said 3-dimensional thinking. That's basically our mantra and what we stand for.

We often use that term sometimes tongue-in-cheek when we're talking to our partners and people we work with out in the community and anybody else in the whole wound care ecosystem. But it's this ability to kind of foresee problems or foresee issues in that wound. And technology really allows us to get those answers in a meaningful and efficient manner. We are very bullish on how mobile pieces of technology can assist us in guiding us to provide better clinical answers and clinical decisions that can improve the outcomes for our patients. And I think Rob certainly has an appreciation as a director of QAPI, he sees it, he feels it, he's appreciating it in his reports that he generates for our post-acute care facilities, especially from a QAPI perspective. There's a tremendous amount of growth mobile wound care space right now from a technology perspective. We're just barely scratching the surface, but that's something that is exciting for us as an organization to really lead our peers who are sometimes, perhaps not aware that this technology is even available. And you'd be surprised even in wound care centers they underutilize mobile wound care technology as well. It's our sincere hope that that's going to change and the landscape is going to improve from this as well.

How do mobile devices contribute to efficient data collection and documentation in wound care?

Robert Calalang, BSN, RN, CWS:

The advantage of utilizing the latest technology is that we're able to store the information safely in a HIPAA compliant cloud-based software that is available to us at any given moment. The same breath, we're able to obtain any information from the past or present to fully review the data in real time. This in turn allows us to document in an accurate and efficient way in our patient's medical records. Then we can compare the information side by side and implement measures to ensure accurate documentation and of course the completeness of wound-related data captured through our mobile technology.

About the Speakers

Haresh S. Kane, MD, CWSP is the founder and Chief Executive Officer of Kane Wound Care. Dr. Kane pursued his medical degree in Hungary where he graduated Cum Laude in 2003. To this day, he remains fluent in Hungarian and often cites that experience as a defining moment in his life. Yearning to pursue his education further, he then trained and completed an Internal Medicine residency program at Jersey Shore University Medical Center, a teaching institution which was, at the time, affiliated with Robert Wood Johnson Medical School. Dr. Kane is Board Certified and a Diplomate of the American Board of Internal Medicine. He also maintains certification with the American Board of Wound Management where he holds the coveted designation of CWSP (Certified Wound Specialist Physician). With the goal of disrupting the current wound care delivery model of healthcare, along with the beliefs that every patient is entitled to high quality wound care and that the clinician is the one who should travel to the patient, not the other way around, Dr. Kane founded Kane Wound Care, formerly Princeton Wound Care, to deliver bedside wound care. Since then, he has grown the company to become a wound care provider group in New Jersey, servicing nursing homes, assisted living facilities and independent living facilities. 

Robert Calalang, BSN, RN, CWS is the Director of Quality Assurance and Performance Improvement at Kane Wound Care. He is a Registered Nurse and obtained his Bachelor’s Degree in Nursing from Felician University. He has been in the nursing home industry since 2007 starting as a receptionist, rehabilitation tech, and then working his way up in the clinical field as a staff nurse, unit manager, assistant director of nursing, director of nursing, and lastly as an assistant administrator. During that time, he also worked as a trauma nurse at Jersey Shore Medical Center, a level one trauma hospital, to improve his assessment skills and clinical practices.