Article

By Gwen Turnbull, RN, BS, CETN

Protocols, critical pathways, guidelines, algorithms—are they really valuable and necessary for the day-to-day business of caring for wounds? Absolutely. They are not only necessary; they are essential for a health care provider’s economic survival in the competitive and litigious health delivery environment we face today. The time has come for all vested parties to understand that caring for wounds means much more than just changing dressings and doing things because “this is the way it has always been done.” 1

Educational resources are essential because each year more than one million new wound care cases need effective wound care that is provided cost effectively.2 Compounding this problem is the small number of specialized wound care clinicians to manage the wounds of millions of patients. Consequently, the bulk of wound care is being provided by nonspecialized clinicians, many of whom lack adequate knowledge needed for optimum wound assessment and care.3,4 Despite the existence of national guidelines, published research findings, and modern wound care products and technologies, wound care practices continue to be largely tradition based, and the cost of wound care products is repeatedly considered synonymous with the cost of care. 5–7

Educational resources, such as algorithms and critical pathways, help clinicians sequence problem-specific interventions and execute them consistently, enhancing the patient’s potential to meet desired outcomes within a designated time frame. At the same time, they collect and provide valuable outcomes data. Increasingly, third-party payers and business coalitions view these tools as a means of evaluating the quality and value of care—a health care organization’s critical “bottom line.” Increasingly, payers and health care businesses focus on the use of these tools as a factor in deciding which providers to form relationships with and to evaluate the care their patients and beneficiaries receive.8

However extraordinary such tools are, they will be rendered ineffective unless their impact on outcomes, cost, and resource utilization in a variety of health care settings is evaluated and analyzed. The fact that wound care costs must be controlled is self-evident. Cost-effectiveness is more than the cost of products or the labor required to use them. It is the cost of producing the desired outcome. Education—of the health care professional, the regulator, the payer, the patient, and the provider—about the outcomes of modern wound care practices is the key to accelerating its widespread acceptance and implementation.

Regulators and accrediting agencies are no longer willing to pay for clinicians to treat wounds and change dressings; today the emphasis is on healing wounds. Algorithms and other clinical tools may assist in providing accurate and complete outcomes data—the valued “products” of health care delivery today.

The road to positive outcomes is paved with educational resources such as algorithms and critical pathways. Like similar products within a wound-dressing category, variances exist among educational resources. Unfortunately, few algorithms and decision maps in the area of wound care are research based; in fact, many lack an evidence base to support their efficacy.9,10 However, a trend toward validation of these tools for use in the populations for whom they were designed is beginning to emerge. The call for evidence-based health care built on solid education has become an international phenomenon.11

Because of the difficulty some clinicians have in accepting the reality and responsibility for economics in their daily practice, health care professionals sometimes view for-profit manufacturers with a jaded eye. 12 Our nation’s economy is driven by profit. Without profit neither industry nor today’s health care providers would survive. The care of wounds takes a large bite out of every health care dollar, regardless of the setting in which it is provided. The goals of both industry and wound care professionals must be a mutual one—to serve patients with wounds and those who care for them more completely and profitably.

The wound care community is fortunate to have unparalleled support from the manufacturers of wound care products and technologies. To develop and produce the educational resources provided as value-added services by many manufacturers would deplete most health care organizations’ already strained budgets. Many of these resources are generic in nature and incorporate resources valuable at all levels of health care delivery. Mandatory and ongoing staff and patient education requires a significant investment of time and money—the programs themselves can be expensive to produce and present. In many instances, manufacturers have developed patient and professional education programs that meet costly educational requirements of national, local, and/or state certifying agencies.

When developing educational resource programs, health care administrators should be aware of the helpful programs already available to them at minimal or no cost. Health care organizations should carefully investigate the value-added educational resources and services provided by a manufacturer before entering into a long-term business relationship. Manufacturers and their value-added educational resources can be strategic partners in eliciting positive wound care outcomes.

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