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A pediatric acute wound service: a novel approach in wound management
B T Bucher1, J Seigel, E Rosenblum
1Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University, School of Medicine, St. Louis, MO, USA.
Insights
The Pediatric Acute Wound Service (PAWS) successfully transitioned pediatric wound care to an outpatient setting, reducing patient visits and operating room use. This program proved profitable while improving efficiency in managing pediatric skin and soft tissue infections.
Area of Science:
- Pediatric Surgery
- Ambulatory Care
- Wound Management
Background:
- Developed in 2001 to manage increased pediatric wound visits and reduce operating room utilization.
- Established the Pediatric Acute Wound Service (PAWS) for ambulatory burn and procedural sedation care.
Purpose of the Study:
- To evaluate the initial 7-year experience and outcomes of the PAWS program.
- Assess the program's impact on patient management and hospital resources.
Main Methods:
- Retrospective review of 7620 children's hospital records from 2001-2007.
- Analysis of patient demographics, visit frequency, procedure details, wound etiology, and reimbursement.
- Statistical analysis using chi-squared tests and linear regression.
Main Results:
- Outpatient visits increased from 51% to 68% (P < .05) between 2001 and 2007.
- Average visits per patient decreased from 3.9 to 2.4 (P = .05).
- Management of wound and soft tissue infections rose to 74% of visits in 2007.
- PAWS generated a $4.0 million contribution margin in 2007.
Conclusions:
- PAWS enabled a shift of pediatric skin and soft tissue wound/infection management to an ambulatory setting.
- The program effectively reduced reliance on operating room resources.
- PAWS operates profitably, demonstrating a sustainable model for pediatric wound care.
Introduction:
In 2001, in response to an overwhelming increase in patient visits for various pediatric abscesses, burns, and other wounds, an ambulatory burn and procedural sedation program (Pediatric Acute Wound Service, or PAWS) was developed to minimize operating room utilization. The purpose of this study is to report our initial 7-year experience with the PAWS program.
Methods:
The hospital records of all children managed through PAWS from 2001 to 2007 were reviewed. Outcomes measured include patient demographics, number and location of visits per patient, procedure information, cause of wounds, and reimbursement. chi(2) test and linear regression were performed using GraphPad Prism (GraphPad Software Inc, San Diego, CA).
Results:
Overall, 7620 children (age 0-18 years) received wound care through PAWS from 2001 to 2007. There were no differences in patient age, race, and sex during this time period. Between 2001 and 2007, the percentage of patients seen as outpatients increased from 51% to 68% (P < .05), and the average number of visits per patient decreased from 3.9 to 2.4 (P = .05). In, 2007, 46% of the children required only 1 visit. In 2007, 74% of the visits were for management of wound and soft tissue infections, compared with only 9% in 2001 (P < .05). The contribution margin of a PAWS visit and total contribution margin in 2007 were $1052 and $4.0 million, respectively.
Conclusion:
The creation of PAWS has allowed for the transition in management of most pediatric skin and soft tissue wounds and infections to an independent ambulatory setting, alleviating the need for operating room resources, while functioning at a profitable cost margin for the hospital.
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