Telemedicine for Problematic Wound Management: Enhancing Communication Between Long-Term Care, Skilled Nursing, and Home Caregivers and a Surgical Wound Specialist

Marek Dobke, MD, PhD; Alicja Renkielska, MD, PhD; Joan De Neve, RN; James Chao, MD; Dhaval Bhavsar, MD


Wounds. 2006;18(9):256-261. 

In This Article

Abstract and Introduction


A wound care program with trained "field" specialists (RNs and LVNs) to assess wounds and prepare management plans for patients and residents in long-term care, skilled nursing, and home care has been developed. To communicate effectively with a surgical wound care specialist (board-certified plastic surgeon), a communication tool (electronic patient record and digital wound photographs transmitted as e-mail) was created. The purpose of this study was to assess the accuracy of wound evaluations based on records and images electronically transmitted by a consultant as the same consultant subsequently verified the evaluations during direct encounters with the patient. From 2003 through 2005, 120 patients were seen during the course of telemedicine and subsequent direct consultations. In only 2 cases (1.67%), upon physical examination, the surgeon changed the previously established diagnosis and management plan. Telemedicine consultations provide accurate chronic wound assessment, and management plans created prior to a direct evaluation by a specialist are valid.


Telemedicine consultations are introduced to enhance communications between "specialist" and "primary care" providers. In the case of problematic wounds frequently affecting the elderly, frail, and non- or poorly-ambulatory patients and those individuals with poor health, telemedicine not only increases access to specialists for patients in rural settings but also facilitates communication in urban settings, reducing costly, emotionally and physically stressful transportation and shortening the time needed for implementation of the management plan with or without surgical intervention.[1,2] Since accurate wound assessments, evidence-based management plans, and prompt access to specialists when needed are crucial to improve outcomes of care, particularly in patients with problematic wounds, this study was undertaken to determine the effectiveness of electronic communication for diagnostic and therapeutic plan development purposes.[3,4]


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