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Impact of:
a specialist wound clinic
on patients who
develop complex wounds
post cardiac surgery
Presented by:
Penny Gowland ANP
Pascaline Njoki
Thanks to: Mr S Datta and Jenifer Dalloway RGN
Introduction
• Background to setting up the wound clinic
• Evolution of the clinic
• Impact on service delivery
• Impact on patients
• Evidence based practice
• Ongoing plans
Surgical Sight Infection (SSI)
Cardiac surgical patients have high risk factors for
developing SSI.
Health Protection Agency data for 2012:
SSI rates for cardiac surgery range from 0.49% to 18.8%,
With the average SSI rate in the UK 4.4%.
2007-2008 The Manchester Heart Centre had had an
increased incidence of SSI and this was impacting on
service delivery and patient care
Not just dealing with the problem
work done to optimize care and reduce SSI
Where we started:1.2.07-1.6.08
Median discharge in SSI patients
56 days
Incident Forms specific to wound
problems
4
Follow up clinic over running due to
wound management problems
16%
Specialist Care post discharge
0%
Readmissions
24%
Paradigm shifts
• What are we doing for an inpatient with an SSI
• Is it feasible to manage them at home
• Is it safe to manage them at home
• Can the patient engage with an outpatient treatment plan
• Utilizing advanced wound care management in the
outpatient setting e.g. Vacuum Assisted Closure devices
The objectives for the wound clinic
• facilitate early discharge
• offer specialist outpatient care
• reduce readmission rates
• facilitate timely readmission if appropriate.
• enhance the quality of care given to outpatients with SSI
The initial impact on service delivery
1/2/07 to
1/6/08
30/6/08 to
30/1/09
Median discharge in SSI patients
56 days
35 days
Incident Forms specific to wound
problems
4
0
Follow up clinic over running due to
wound management problems
16%
0
Readmissions
24%
0%
Specialist Care post discharge
0%
100%
Seamless service
Aims:
• Establish communication with the community staff
• Empowering patients to self care or seek help for wound care.
Actions:
• Altering information given at pre and post surgery
• Writing to district nurse as well as GP.
• Developing a website for access by primary care staff.
• Alterations to the Discharge Notification Form to include
information on wound care and follow up.
• Writing an information leaflet to educate patients how to care for
their surgical wounds on discharge.
Measuring Patient Satisfaction
Jan – May 2011
• Were the patients getting the correct information?
• Were we helping the patients to get continuation of care
between the primary care team and the wound clinic by
communication and ensuring the patients have dressings
and medications?
• Were we meeting the needs of our patients?
• What were their experience of the wound clinic?
• Could we do anything better?
A patient satisfaction questionnaire
administered to 21 patients
by post or hand delivery after their clinic visit
Questions asked were:
•About themselves
•About the wound clinic / department
•About the staff
•About their treatment
•And, overall rating of the care provided
•Response rate was 100%
Gender distribution
24%
Male
Female
76%
Patients were asked to indicate about
information made available to them.
• n=10 (48%) were offered information leaflet on discharge
• n=8 (38%) via liaison team.
• n=21(100%) knew where to attend the clinic
• n=13 (62%) good signage to department
Why appointment was made
Others specify
I phoned Liaison team
District Nurse worried
Made for me before discharge
0
1
2
3
4
5
6
7
8
9
10
Were you seen at your appointment time?
14%
n= 18 (86%) were seen
at appointment time
Yes
No
n= 3 (14%) ambulance
issues-1
86%
Please rate how you felt you were dealt with
by the following staff during your visit:
n=17 (81%) rated the reception staff very good
n=21 (100%) rated the nursing staff very good
n=17 (80%) rated the medical staff very good
n=19 (90%) rated the ANP very good
n=21 (100%) had confidence and trust in doctors / nurses
treating them
About treatment
•n=15 (71%) had dressing regime
changed
•n=8 (39%) got a a prescription of
either antibiotics/dressings or
both
5%
10%
24%
Antibiotics
p
•n=21 (100%) understood the
next steps of their treatment
•n=18 (86%) got a note for their
district nurse
Dressings
Not Applicable
Both
61%
Overall rating of care
Decision making
90% of patients said
they were happy with
their involvement in
decision making.
5%
0%
Very good
Good
Ok
Poor
Very poor
95%
What do you like best about our clinic?
• Very little time spent waiting (2)
• good advice (2)
• Care and attention of all staff (3)
• Felt staff were interested and capable and had time to talk (1)
• Care given-keep up the good work (1)
• reassurance (1)
• The professionalism and friendliness and warmth of the staff (2)
The wound clinic has had an impact:
• Reduced Length of stay
• Given specialist care post discharge
• Reduced Readmission Rates
• Stopped over running of general clinics due to
wound care interventions
• Achieved good satisfaction rates with their clients
Objectives
100% of patients to receive information leaflet on discharge
Signage to out patient department was being reviewed by management
Developing a cardex for wound clinic to have a continuous audit of
-Activity in the wound clinic
-how frequently we see patients
-treatments given
-time to wound to closure
-Clinical and cost effectiveness of treatments
Changes to the wound clinic in the interim
• Twice a week availability, two clinics in two different locations
• Changes to the way patients were discharged from hospital
• Changes to the working patterns of the Cardiac Liaison Team
Re-audited Patient Satisfaction Jan-June 2013
• 35 questionnaires were given to patients attending wound
clinic or by post
• 24 were returned completed (69% response rate)
• Asked the same questions about the patient
demographics and their experience
Demographics
Remained similar between the two audits
17%
Male
Female
83%
Patients were asked to indicate about
information made available to them.
• n=6 (25%) were offered information leaflet on discharge
• n=3 (12.5%) via liaison team.
• n=22(92%) knew where to attend the clinic
• n=13 (54%) good signage to department
Why appointment was made
How appointment was made
14
12
10
8
6
4
2
0
Made for me before discharge
District Nurse worried
I phoned Liaison team
Others specify(GP referral)
Change in trend: more patients being given appointments on discharge and
More GP and DN referrals and less from Liaison Team
Were you seen at your appointment time?
n= 21 (88%) were seen
at appointment time
13%
n=3 (12%)
Yes
No
87%
Please rate how you felt you were dealt with
by the following staff during your visit
n=21 (88%) rated the reception staff very good
n=21 (88%) rated the nursing staff very good
n=20 (83%) rated the medical staff very good
n=20 (83%) rated the ANP very good
n=24 (100%) had confidence and trust in doctors / nurses
treating them
About treatment
•n=21 (88%) had dressing
regime changed
•n=14 (58%) got a a
prescription of either
antibiotics/dressings or both
•n=21 (88%) understood the
next steps of their treatment
•n=5 (20%) got a note for
their district nurse
•n=23 (96%) patients had
advanced wound care
• n=18 (75%) had Deep
wound cleaning
• n=4 (17%) had VAC
therapy
• n=1 (4%) had platelet
gel therapy
Overall rating of care
Decision making
92% of patients said
they were happy with
their involvement in
decision making.
4% 0%
17%
Very good
Good
Ok
Poor
Very poor
79%
What do you like best about our clinic?
• Listening (5)
• Information Given (10)
• Treating me as a person (2)
• Care and attention of all staff (19)
• Given reassurance (2)
• The professionalism and friendliness and warmth of the staff (7)
What we could improve on?
• Information on discharge (3)
• Communication between reception staff and medical team
(1)
• Too frequent visits (1)
• Signage at MRI generally (1)
• Location of clinic (3)
• Prefer to have this type of treatment nearer home (1)
• More staff needed (1)
“I have found all my treatment on the cardiothoracic
wound clinic extremely satisfying. Every member
of staff has been very efficient, considerate,
helpful and polite. I have found getting
appointments, even in an emergency, very quick.
All in all, I have received a very good service from
the department and staff.”
Conclusions and action plans second round
of patient satisfaction audit
• Continue to get good feedback
• Getting good engagement from Primary care team
• Revisit the information given in the Discharge Notification
Letter and How To Look After Your Surgical Wounds
leaflet to reflect the current wound clinic and information
about where the clinics are held.
• Work with the new discharge process to ensure that the
patients get given the information
Developing a data base
• Real time information about outpatient management and
trends in the wound clinic
• Generate automatic reports where new infections are
diagnosed
• To be able to evaluate clinical and cost effectiveness of
treatments
Database to give real time data