The global wound care market is a growing industry, projected to reach $20.5 billion by 2020. But despite the constant introduction of new products and advanced technologies, managing a wound care program remains a notoriously difficult challenge.
That’s because the wide range of products, caregivers and treatments used creates many uncertainties around patient outcomes and costs. These uncertainties, as well as efficiency and quality improvement demands arising from healthcare reform, are driving new innovations in wound care. Innovations are centered not just on products, but also on standardizing the wound care process itself.
Treatment Advances
Several advances in wound care treatment have emerged in recent years, including the use of negative pressure wound therapy, nanocrystalline silver dressings and advanced dressings.
Introduced in the 1990s, negative pressure wound devices (NPWDs) are now widely used to treat acute wounds. The devices work by sealing the wound and draining away excess fluid with a vacuum, helping to speed closure and recovery.
NPWDs have been associated with lower overall volume and dimension of wounds, which can mean less complex reconstructive surgery for patients. But the devices are relatively expensive, and some suggest they’ve been overused for chronic wounds.
“Medicare is now taking a closer look at these devices, related to patient outcomes, including the appropriate use and patient safety,” says Mary Crossland, RN, BSN, CWOCN. Crossland is director of the HCA Virginia Wound Healing Network and has also worked on multiple high-profile clinical trials. “I’m glad to see that these devices, as well as others, are being reviewed. We need to ensure that all devices and products that we’re using are delivering the best outcomes to our patients.
“They’re convenient because they get changed only three times a week, but there aren’t strong data to show they affect the time to closure in chronic patients,” she continues.
Silver is one of the oldest known wound treatments, with nanocrystalline silver dressings representing one of the latest advancements in wound care technology. This type of dressing has an ultra-thin layer of silver at the wound interface, providing a large initial dose of silver followed by a continuous release to help fight infection.
The advanced wound care and closure market for ulcer treatment is expected to grow to over $7.8 billion by 2020 with the diabetic foot ulcer management segment being prominent. Source: Allied Market Research, July 2014: www.alliedmarketresearch.com/wound-closure-wound-care-market
Silver’s antimicrobial properties make it effective for combating a broad spectrum of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Nanocrystalline silver dressings are more expensive than traditional silver dressings, but they can last for days, reducing labor costs relative to dressings that require multiple changes daily. This, in addition to their ability to reduce infection, lowers treatment cost and length of hospital stay.
“The real workhorses in wound care have always been silver, hydrocolloids and hydrofibers,” says Crossland, who maintains that simpler treatments are often more effective than expensive, high-tech options.
Advanced hydrocolloid and hydrofiber dressings have multiplied in recent years as researchers design new enhancements aimed at speeding wound recovery. Hydrocolloids form a gel upon contact with the wound surface, helping to maintain a moist healing environment, whereas absorptive hydrogels and hydrofibers are used for wounds with excess fluid.
New options include combination dressings, such as hydrofiber dressings that contain ionic silver to fight infection. They are more expensive than traditional gauze, but studies indicate faster healing times may lower total costs.
Skin substitutes are also growing in use, mostly for burn injuries where insufficient tissue exists for autografting, or where allografts or xenografts present other immunological or cultural issues. They’ve also been successfully used to treat pressure ulcers. However, bioengineered skin substitutes remain a costly treatment.
Research Frontiers
Wound care researchers are exploring advanced methods to stimulate wound healing, including the use of growth factors. These biologic wound products augment the inflammatory mediators that drive the healing process.
Studies demonstrate that growth factors decrease amputations in patients suffering from diabetic foot ulcers, but the treatment can be somewhat expensive. To date, the FDA has approved only a select number of growth factors for the treatment of chronic wounds, including the rarely used becap-lermin (brand name Regranex).
“You can hardly find it being used anymore,” says Crossland, who was involved in the drug’s first clinical trial. “At the end of the day, the data just weren’t that strong.”
Researchers are also investigating the use of advanced tissue engineering techniques, including stem cell and gene therapy, to support the body’s natural wound healing processes.
While these new technologies may take years to work through clinical trials and regulatory approval, a different type of innovation—one focused on process improvement—offers real promise for lowering costs and boosting quality of care.
A New Approach
Eight peer-reviewed studies demonstrate the effectiveness of Solutions Algorithms. Key data from those studies include a 90 percent reduction in days to heal, a 25 percent reduction in average length of stay and a 56 to 69 percent reduction in treatment costs.
Central to Solutions Algorithms is a five-step treatment pathway designed to help bedside nurses clean, measure and stabilize wounds, as well as select the appropriate first dressing based on a streamlined formulary.
“It helps nurses know what to do so they can initiate treatment while the patient is waiting to be seen by a specialist,” says Melayne Martin, RN, CWOCN. Martin is the wound program manager at Parkland Health and Hospital System in Dallas, which partnered with ConvaTec in 2012 to implement Solutions Algorithms.
The scaled-back formulary means nurses need to familiarize themselves with only a few key products, helping improve efficiency and reduce waste.
“Many of our nurses were either using plain gauze or going straight to negative pressure [wound devices],” Martin says. “They weren’t familiar with any of the advanced wound care dressings in between that can provide proven outcomes.”
Simplifying the dressings and protocols used helps eliminate guesswork for non-experts and aids wound care program managers in tracking outcomes.
Since the pilot program at Parkland started, Martin has documented more than $40,000 in cost savings in wound care supply costs alone. She also found that standardization reduces inventory, requires fewer suppliers and lowers costs through increased purchasing leverage.
“You can provide advanced wound care in a standardized way that improves outcomes without increasing your spend,” Martin says. “We want to do the best we can for our patients, but we’re also a county hospital, so we have to look at how we finance that,” she adds.
Implementing ConvaTec Solutions Algorithms involves three phases. In the first phase, ConvaTec helps clinical teams customize the bedside nursing pathway and product formulary, with opportunities for teams to insert their own protocols as needed. The second phase brings live education to the organization, and the third phase provides ongoing support from ConvaTec.
As with any new program, there’s bound to be pushback, something Martin uses as an opportunity to clarify the algorithm’s purpose.
“Wound care nurses sometimes tell me they don’t want to use the algorithm because they think it takes away their ability to make expert decisions,” Martin says. “I always tell them, the algorithm isn’t meant for the professional wound care nurse. It’s for the front-line nurse who needs confidence in providing care—not when the specialist is at the bedside, but when they’re by themselves at night.”
Parkland is still collecting data on patient outcomes, but Martin is very satisfied with the benefits her facility has already achieved as a result of standardizing care.
“This is a way you can treat wounds safely with evidence-based practice,” she says. “And you can do it for a reasonable price.”
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