3/21/2016
Introduction to the Lower Extremity Wound Pathway
Dr. Brian Ulmer
Dr. Tessa Laubscher
Saskatchewan Lower Extremity Wound Pathway Clinical pathway for the standardization and improved management of chronic wounds:
– Venous ulcers
– Arterial ulcers
– Diabetic ulcers – neuro‐ischemic
– Mixed etiology ulcers
Does not include pressure ulcers.
Why a Pathway? High number of acute care interventions • 189 amputations due to diabetic foot wounds in Saskatchewan in 2014/15.
• Over 6,000 days of hospitalization for diabetic foot wounds in 2014/15.
• Over 1,700 days of hospitalization for venous wounds.
• ER visits/homecare hours? – provincial data not currently available, but probably high!
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3/21/2016
Why a Pathway? Growing problem
• Estimated 7.2% of persons with diabetes will develop foot ulcers this year.
8,000
7,000
hospitalization days with
diabetic foot wound
6,000
5,000
4,000
hospitalization venous
wounds
3,000
2,000
1,000
0
09/10 10/11 11/12 12/13 13/14 14/15
Why a Pathway? Clinical challenges identified:
• Inconsistent access to wound care services.
• Primary care providers lack information about
local/regional resources for wound care or prevention.
• Wide variation in treatment plans and referral patterns for wound care patients.
Potential benefits to providers
• Standardized protocols for assessment & treatment of wounds
• Tools for collecting and sharing information among providers
• Capacity‐building for wound care teams.
• Clear criteria for specialist referral.
• Timely access to appropriate specialist.
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3/21/2016
Potential benefits to patients
• Improved teamwork and communication among care providers.
Worldwide data • Resources for patient suggests that 50% of education
diabetic foot amputations could be • Faster healing, avoid avoided with early hospitalization or identification and multidisciplinary clinical amputation. care.
Most common chronic lower extremity wounds
• Venous ulcers –60‐ 80% of LEWs
•
•
•
•
Diabetic foot ulcers/PAD
Saskatoon clinic 4 half days per week
About 350 visits per month
300 patients with homecare at any given time
Peripheral neuropathy
Sets the stage for:
–Ulceration at pressure points
–Unsuspected injury
–Infection
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Venous Stasis
ACUTE INFECTION
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