The value of cost-effectiveness research in all areas of healthcare, including wound care, is increasing. The purpose of this narrative review is to discuss and critically examine economic analysis methods and determine how current knowledge should be applied to wound care. Unlike evidence-based medicine, there is less agreement on how to conduct economic analyses in healthcare and universal guidelines for reporting these studies are lacking. A review of the literature shows that, in wound care, economic analysis is mostly limited to cost-benefit analysis with a limited time horizon; several examples specific to venous ulcers are presented. In addition, most analyses are models based on prospective studies; this is an especially important consideration because chronic wounds may take a long time to heal and/or recur. Other economic analyses that may be very useful to evaluate include those based on “real world” or practice-based studies, which provide results for all wound care populations and can be compared to facilitate development of cost-effective strategies for wound care treatment. Currently available cost-effectiveness study results may help healthcare providers devise cost-effectiveness strategies to embed in clinical practice guidelines that will save costs and improve patient quality of life.

Abstract

  Triage is the process of prioritizing patient care based on need and available resources. Clinicians in wound clinics triage daily because time and resources never seem to be sufficient. The triage concept is taken to an extreme when a disaster strikes — the clinical goal of patient care transforms from the individual patient to providing the greatest good for the greatest number of patients. Situational awareness of system resources is of paramount importance in a disaster. Planning for surge capacity while simultaneously attending to patients who require immediate attention is a must. The recent earthquake in Haiti provided an opportunity to test those skill sets. Scores of clinicians volunteered their time and expertise, elevating wound care to the status of a clinical division. The experience of providing quality wound care despite a myriad of situational limitations suggests that busy wound clinics can learn valuable lessons from the realm of disaster management. The rate of under- and over-triage in wound clinics can be reduced by utilizing commonly collected outcomes and operational data. Patient safety improves when the hierarchy is flattened, communication is open, checklists are used, debriefings are held, and teamwork is encouraged. Reflecting on the working conditions in Haiti, it is clear that patients and clinicians benefit when success is measured by patient outcomes instead of individual accomplishments.

  Geriatric home health nurses care for a large number of elderly patients with gastrostomy tubes (G-tubes). The elderly patient who requires a G-tube typically has multiple medical problems and cannot obtain adequate nutrition. Nurses play a critical role in educating the patient and caregivers about G-tube site care and how to monitor for complications.

  A frequent complication is the formation of hypergranulation tissue — ie, granulation tissue progressing beyond the surface of either the wound bed or the intact skin surrounding the wound. Hypergranulation tissue is most likely the body’s response to the foreign tube. The G-tube causes irritation in the G-tube tract and inflames the epithelial tissue, preventing the skin from creating a snug fit around the tube. This inflamed epithelial tissue poses a number of problems: 1) the tissue is fragile and bleeds easily, concerning caregivers who often think the bleeding is coming from inside the patient’s stomach; and 2) drainage from the tissue can cause skin irritation, excoriation, and skin breakdown, increasing the risk of infection in patients with already compromised health status. Hypergranulation tissue also prevents the migration of epithelial cells so the area will not heal.

  Health literacy can be defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”¹ According to the Centers for Disease Control and Prevention,¹ only 12% of adults have the skills needed to effectively manage their health and prevent disease.

  For ostomy patients, the timing and content of education is crucial in helping improve their health literacy and adjusting to living with an ostomy. Clinicians should keep several points in mind, some of which they may or may not have been able to address during hospitalization: