In a statement from the Alliance of Wound Care Stakeholders, a multidisciplinary trade association of physician specialty societies and clinical and patient associations, it has been emphasised that wound care is an essential—not elective—service that prevents admissions to hospital among “a fragile cohort of patients at high risk of COVID-19”.
The rapidly evolving COVID-19 pandemic in the USA has prompted hospitals and acute care facilities to change standard operating procedures in preparation for the expected influx of infected patients. As a result, services, procedures, and surgeries that are deemed “non-essential” are being shut down immediately, “without thorough consideration of the ramifications” says the Alliance of Wound Care Stakeholders.
Outpatient-based wound care departments have been placed in the non-essential group by many hospitals. The Alliance of Wound Care Stakeholders has expressed concern that this decision will result in unintended negative consequence and trigger a gradual influx of patients to the emergency department (ED).
Non-healing wounds, left untreated and unmanaged, can result in significant medical issues including infection, sepsis, the need for limb amputation, and even death. As a result, many procedures provided by wound clinics are considered to be essential, in order to protect the health of patients and prevent an escalation of their disease.
Individuals with chronic wounds commonly have other chronic conditions, such as type 2 diabetes, hypertension, venous insufficiency, peripheral arterial disease, and/or chronic kidney disease. This cohort of fragile patients is high risk if they develop COVID-19, but are also high risk for increased morbidity and mortality if their access to wound care is abruptly discontinued.
Addressing the COVID-19 pandemic and the importance of avoiding unintended consequences for wound patients, the Alliance states: “Across the country, wound care providers are working to ensure that the health of our patients is protected during the COVID-19 crisis. We are adopting aggressive infection control and social distancing precautionary measures at our sites and with our staff.
“While wound care providers are working to limit clinic visits and move as many patients as practical to telehealth, office visits or home health follow-up where appropriate, wound clinics must be able to provide those urgently needed wound care procedures that are infection-sparing, limb-saving and life-saving. These procedures are essential, not ‘elective,’ and ultimately will reduce wound patients’ potential for needing other hospital services such as operative intervention or amputation, which require prolonged hospitalisation.”
In terms of their position on this matter, the Alliance of Wound Care Stakeholders have made their stance clear, advising healthcare systems to “leave clinics open to manage complex wounds in clinically complex medical patients who are at risk for limb loss, hospital admission, amputation or infections”.
They continue: “Hospital administrations should take into consideration input from providers when making these decisions, and deploy appropriate triage criteria when reducing essential clinical services. Enabling continuity of care for these wound patients will improve outcomes while unburdening emergency departments, operating rooms, hospital staff and hospital beds for the COVID-19 crisis. Keeping these patients out of the ED and out of hospital beds can in turn limit exposures and curb COVID-19 infection among this fragile population.”
Finally, the Alliance has confirmed the creation of a task force to help wound clinics and health systems address the evolving realities of the COVID-19 pandemic while avoiding unintended consequences for wound patients. Recommendations will be circulated shortly and can be obtained directly by contacting the Alliance.
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