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Published on: December 4, 2021
Wound Care Consultation in Postacute/Long-term Care: Characteristics and Practice Implications
Jeffrey M Levine1, Gary Brandeis, Santhini Namagiri
1Jeffrey M. Levine, MD, AGSF, CMD, CWS-P, is Associate Clinical Professor, Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York; and Consultant, Advantage Surgical & Wound Care. Gary Brandeis, MD, CMD, is Chief, Geriatrics, Mt Sinai Services, Elmhurst Hospital Center, New York; and Clinical Professor, Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai. At The New Jewish Home in New York, Santhini Namagiri, MD, is Physician; and Ruth Spinner, MD, CMD, is Medical Director. Acknowledgments: The authors thank Orah Burack, Senior Research Associate at The New Jewish Home, who assisted with study design and institutional review board submission; and Shark Bird, MD, Chief Medical Officer of Vohra Wound Physicians, who provided insights into models of wound care. A subset of 27 residents from this database was analyzed and previously published as Levine JM, Menezes R, Namagiri S. Wounds related to malignancy in postacute/LTC: a case series. Adv Skin Wound Care 2020;33:99-102. Parts of this article were presented as an abstract at the AMDA/PALTC Annual Meeting in Atlanta, 2019. The authors have disclosed no financial relationships related to this article. Submitted September 2, 2020; accepted in revised form October 28, 2020.
Objective:
To study the characteristics of residents in postacute (PA)/long-term care (LTC) facilities with wounds and prevalence of wound types other than pressure injuries (PIs).
Methods:
The authors conducted a retrospective review of all wound care consultations over 1 year at The New Jewish Home, a 514-bed academically affiliated facility in an urban setting. Investigators analyzed residents by age, sex, type of wound, presence of infection, and whether the resident was PA or LTC. Authors designated PIs as facility acquired or present on admission.
Results:
During the study period, 190 wound care consultations were requested; 74.7% of consults were for those in PA care. The average patient age was 76.3 years, and there were 1.7 wounds per resident receiving consultation. Of studied wounds, 53.2% were PIs, 15.8% surgical, 6.8% arterial, 6.3% soft tissue injury, 5.8% venous, 2.6% malignant wounds, and 2.1% diabetic ulcers; however, 11.6% of residents receiving consults had more than one wound type. In this sample, 13.2% of residents had infected wounds, and 76.2% of PIs were present on admission.
Conclusions:
The wide variety of wounds in this sample reflects the medical complexity of this population. The transformation of LTC into a PA environment has altered the epidemiology of chronic wounds and increased demand for wound care expertise. These results challenge traditional perceptions of wound care centered on PIs. Given its importance, a wound care skill set should be required of all PA/LTC providers.
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