Telewound sessions: Best practices when conducting virtual appointments

Telewound

With the COVID-19 pandemic, telehealth and telewound services are in high demand.

For many wound care clinicians, providing telewound services may be a new addition to their practice.

We spoke with two telewound experts to help you learn more about best practices and possible glitches when conducting a telewound session.

Helpful telewound strategies from Ekbote

Wound care is part of the virtual urgent care services available from the University of Pittsburgh Medical Center (UPMC), said Sundeep Ekbote, MD, FAAEM. He is chief of emergency services at Monongahela Valley Hospital and medical director of UPMC AnywhereCare, Consumer Telemedicine Services.

Wounds are seen as part of the overall virtual urgent care services. Ekbote provides expert insight on best practices below.

Having someone else with the patient can help

Patients typically use the service from their homes, so usually a clinician is not physically with the patient. Exceptions are when paramedics are with a patient, or the patient accesses our service from a long-term care facility.

When a healthcare professional is with the patient, it allows you to obtain vital signs and other objective information.

Having someone help the patient hold the camera near the wound is advantageous, especially for difficult to reach sites such as the back.

Using a mobile device is better than a laptop because patients and others can move it around easier to capture a view of the wound.

Possible disadvantages and glitches

Not being physically with the wound

Managing wounds on an initial visit as a virtual clinician can be challenging. You cannot:

  • Feel for warmth and pulses
  • Discern if an area is soft or firm
  • Take vital signs

These are inherent limitations for initial wound management.

If possible, it’s ideal to see a patient’s wound in-person first. Then use the same clinician for follow-up visits via telehealth. This helps the clinician get a better sense of the wound and its progression.

Not being physically with the patient

While not a deal breaker, it can be a disadvantage when you’re not in the same room with a patient. It’s more challenging to establish a relationship and rapport.

Connectivity issues

Having a solid internet connection is essential. Not having one is a common problem.

Telewound recommendations from Botek

Georgeanne Botek, DPM, FACFAS, head of podiatry at the Cleveland Clinic, offers some helpful tips regarding best practices below.

Botek also is a founding member of the Functional Limb Preservation Council, which is a Cleveland Clinic multidisciplinary collaborative group of physicians and surgeons.

Allow enough time without distraction and interruption

Starting a session late or having to cut it off early can cause you to miss out on vital information.

Both the clinician and patient should be prepared for the visit. Being prepared leads to a smooth encounter.

Patient preparation: It helps when patients know who their treating physicians are, their credentials (role) and have their contact information. This is especially important when providing a second opinion to patients who live out of the area or state, when the clinician is not familiar with the care team.

Clinician preparation: The physician or clinician should ensure the care team follows through on ordering supplies and works together for the patient. This is invaluable.

Confirm the necessary diagnostic exams, such as radiographs, advanced and arterial imaging, and the ordering of offloading devices.

Having access to recent diagnostics is essential.

With foot wounds specifically, having up-to-date radiographs and noninvasive arterial testing available helps communicate the whole pathology.

Sometimes the treating team needs to arrange hyperbaric oxygen, home care, and reach out to communities that are not local. These take time and will extend beyond the podiatrist or provider performing the telehealth visit.

Build a rapport and trust with the patient

Sometimes a tough message needs to be communicated—wounds can lead to amputations about 20% of the time. Ulcer care and limb salvage requires trust and understanding, and having a relationship with patients.

Devote enough time to each visit

Give the patient enough time to trust your treatment advice and provide the necessary education. A good visit is rarely a 10-minute encounter on telehealth.

Use a reliable telehealth platform

Having a reliable telehealth platform is essential. You’ll want audio and visual images effectively transmitted.

In most cases, it is preferable to have live video or real-time communication.

Patient and caregiver together on one end, with a wound specialist on the other end (physician, surgeon, advanced practitioner or nurse).

Obtain a full history

Confirming that patient information is accurate is important because sometimes records are not all electronic at the time of the visit. Ensure you get a good history from either the patient or the caregivers.

Knowing when the problem began and what treatments have already been performed is essential.

This is especially important as the nature of wounds often becomes chronic with years of pathology occurring.

Patient assistance transmitting accurate images

The best interactions are when a family member or home health care nurse is with the patient to assist with obtaining accurate images of the patient’s foot. Or when images are uploaded ahead of time to view before or during a telehealth visit.

Imaging the foot can be challenging for a patient when alone. The saying “a picture tells a thousand words” is truly applicable.

It can determine the treatment path.

  • Does the patient need to be seen in-person for a debridement?
  • Does the patient require hospitalization for an infection or require antibiotics at home?

Try to observe patients’ current medical supplies

Being able to see a patient’s supplies and offloading devices is crucial for a successful telehealth visit.

Good lighting and extremity elevation matter

A bright room and environment, and the ability of the patient to elevate the foot and leg, is vital. This helps the clinician visualize the entire area of both lower extremities.

Prepare for possible glitches to the process

It’s wise to prepare for an electronic glitch. Some examples include:

  • Even with a good picture, you may need to call patients from a landline if the sound is off or of poor quality.
  • You may need to convert platforms, i.e., from a telehealth app that went down to Facetime. The ability to navigate and use different platforms during a visit helps ensure a quality encounter.

Swift Medical, the Wound Care Education Institute and others have partnered to link wound care clinicians around the U.S. The intent of the partnership is to provide patients more access to telewound services to reduce the impact on health systems during COVID-19.

Read more about the Telewound Coalition here.

Register for Wild on Wounds today!

Carole Jakucs

Carole Jakucs, MSN, RN, PHN, is a full-time freelance writer. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, pediatric emergency department and college health. 

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