Published: August 2024
The Virtual Wound Service was established in 2018, and is the first of its kind. It uses a virtual wound consultancy model to provide access to wound care expertise either in person or virtually.
Western NSW Local Health District (WNSWLHD) covers a large, rural area with a widespread population. Virtual care is used by the Virtual Wound Service as it allows consumers and healthcare workers to access wound care expertise from where they are located without having to travel to busy base sites.
The purpose of the Virtual Wound Service is to:
- support clinicians working in rural and remote, community and residential aged care settings
- provide expert consultancy advice
- develop capacity across the district in wound management
- guide clinicians in the delivery of evidence-based wound care delivery
- guide clinicians to assess a patient's wound, identify the cause, select appropriate treatment pathways and escalate care.
The Virtual Wound Service provides:
- review appointments
- case conferencing
- referral
- advice to colleagues
- knowledge, confidence and skills to clinicians across WNSWLHD.
Reasons for change
People living with wounds seek care from a variety of services. These services and their providers vary in knowledge, skill and ability to manage wounds. It can be difficult to access wound care expertise. This contributes to increased healthcare costs and poor outcomes for people living with wounds.
The Virtual Wound Service was established to:
- provide wound care expertise in rural and remote facilities, as they did not have access to a wound specialist. This minimised the potential for adverse consumer outcomes
- remove the need for consumers to travel to a base site, e.g. Dubbo, for review and care
- improve efficiencies by creating new escalation pathways and minimising the need to transfer consumers to overwhelmed base sites
- address issues with staff by implementing flexible workforce models such as nurse practitioners to reduce access and service delays.
Clinician feedback
“The nurse-led virtual wound service is vital for remote health services. It gives nurses a process to escalate complex wound issues. It allows a multidisciplinary team approach for better outcomes for rural clients.”
“The virtual wound care service has allowed staff, consumers, residents and their next of kin, access to wound care expertise without needing to travel. It has improved wound outcomes, by decreasing healing time with the correct use of products, reducing complications and providing valuable education and support.”
“I believe that this service is essential for our district to provide quality wound care to our consumers and reduce costs associated with wound care.”
Consumer story
“I’ll be in compression therapy for the rest of my life, but it’s better than having a wound.”
In the small community of Gulargambone, 66-year-old ‘Michael’* found himself facing a challenge with a recurring lower leg ulcer. Michael sustained a lower leg laceration in March 2023 when an object struck his leg while he was mowing. He had a history of dealing with these type of wounds, dating back 20 years when he lived in Papua New Guinea and had a tropical ulcer.
In March 2023, Michael presented to Gulargambone Community Health Service. The community health team recognised that his wound was chronic and made the decision to refer him to the Virtual Wound Service in May 2023.
The Virtual Wound Service completed a virtual wound consult in May 2023. During the review, the team discussed Michael’s wound, medical history and previous ulceration. They gained an understanding of the underlying issues, including venous insufficiency, to develop an effective management plan.
Collaboration was key, as the care team discussed skill levels regarding compression therapy and the need for further investigations to ensure safe application. The Virtual Wound Service provided both Michael and the community health team with training on compression therapy and venous insufficiency.
Michael and the community health team started compression therapy just two weeks after the initial review. With consistent evidence-based care, the wound had begun to show signs of healing.
Through virtual check-ins by the Virtual Wound Service and ongoing care from the community health team, Michael stayed committed to the wound management plan. Both Michael and the community health team gained newfound knowledge and skills from this experience.
*Name has been changed for privacy.
Key enablers
Structure of the Virtual Wound Service
All WNSWLHD rural and remote acute, community and aged care services can access the service by:
- completing a referral (WNSWLHD intranet)
- providing multiple photographs of the wound using MedSync
- emailing the information to the service.
The Virtual Wound Service is led by a nurse practitioner or transitional nurse practitioner. Referrals are triaged by the nurse practitioner or transitional nurse practitioner and actioned in response to their category.
The service is supported by local healthcare providers, such as a community nurse, Aboriginal health practitioner or aged care worker who directly supports access and provides care for the consumer.
- Nurse practitioner (with medical and clinical nurse specialist oversight)
- Local Health District (LHD) Wound Prevention and Management Clinical Nurse Consultant
- CISCO room-based videoconference
- Laptop or desktop
- Phone
- MedSync app for image upload
- Residential aged care facilities have identified that tablets may be used in the future as they are easier to move around.
Workflow
Prior to the consultation
Clinicians ensure the consumer and their family or carer:
- understand and are familiar with virtual care and their healthcare rights (NSW Health)
- know what will happen in the consultation and how their privacy will be maintained
- have access to the right equipment
- will be in a suitable environment, e.g. space, lighting and sounds (minimal background noise, clear voices, comfortable room temperature).
Early conversations and consideration of these factors support a productive consumer and clinician experience.
The nurse practitioner reviews clinical documentation prior to a meeting with the consumer, their carer and a healthcare worker.
During the consultation
The service offers consultations in person, virtually or a combination of both (hybrid). For a hybrid consultation, healthcare workers are physically present with the consumer, and others are on video.
The nurse practitioner will:
- validate information provided
- ask the consumer, carers and healthcare worker questions
- observe the wound over video
- complete diagnostic investigations supported by the onsite healthcare worker, e.g. a Doppler ankle brachial pressure index for lower limb wounds
- explore the consumer’s management goals
- develop a management plan and treatment regime
- support the healthcare worker to perform the wound treatment on the day, e.g. guide them to apply compression or other wound management products.
Outcomes
Improved consumer experience
- Consumer-centred service
- Reduced consumer travel
- Improved healing rates
Reduced cost of healthcare
- Optimise the use of resources
- Reduction in hospital-acquired pressure injuries
- Reduced readmission rates
Improved staff experience
- Streamlined care – one service across many places and settings (inpatient, outpatient, community)
- Improved healing rates
Improved health of the population
- World class rural healthcare
- Readily available expert wound advice
Acknowledgement
We acknowledge Western NSW Local Health District staff for their support and information provided for this Spotlight.