scholarly journals Multidisciplinary Approach to PAD: Who's on Your Team?

2018 ◽  
Vol 35 (05) ◽  
pp. 378-383
Author(s):  
Sabeen Dhand
Keyword(s):  
Patient Outcomes ◽  
Orthopedic Surgery ◽  
Multidisciplinary Approach ◽  
Wound Care ◽  
Arterial Disease ◽  
Team Approach ◽  
Peripheral Arterial ◽  
Treat All ◽  
Improve Patient ◽  
Care Nursing

AbstractThe complexity of peripheral arterial disease (PAD) and its multiorgan involvement requires the utilization of a multispecialty team approach. Members of this team include a vascular specialty (interventional radiology, cardiology, and vascular surgery), podiatry, orthopedic surgery, primary care, infectious disease, endocrinology, plastic surgery, wound care nursing, and dietetics. A team approach has been proven to significantly improve patient outcomes as well as decreasing amputation rates. In order to promote collaboration and avoid duplication of care, the team can be broken down into three main pillars: medical management, wound care, and revascularization. A complete team approach is vital for this population, with an overall goal to treat all manifestations of the disease and prevent further progression and risk of major sequelae of the disease.

Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S34-S40
Author(s):  
Jenni MacDonald
Keyword(s):  
Patient Outcomes ◽  
Wound Care ◽  
Cost Effective ◽  
Theory Of Knowledge ◽  
Care Needs ◽  
Profound Knowledge ◽  
The Cost ◽  
Improve Patient ◽  
Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

Lower limb wounds in diabetes: the challenges of wound healing

2021 ◽  
Vol 26 (Sup9) ◽  
pp. S20-S24
Author(s):  
Krishna Gohil
Keyword(s):  
Wound Healing ◽  
Peripheral Arterial Disease ◽  
Patient Outcomes ◽  
Lower Limb ◽  
Holistic Approach ◽  
Arterial Disease ◽  
Delayed Wound Healing ◽  
Early Referral ◽  
Peripheral Arterial

Managing ulceration in the lower limb for a patient with diabetes can be complex and challenging, requiring a multiprofessional, patient-centred, holistic approach with early referral for specialist review as key. Any delay in referral and intervention can be catastrophic, as time is tissue. Peripheral arterial disease and neuropathy both contribute significantly to the delays in wound healing, and it is important to rapidly recognise the problems with an informed assessment and understand the possible reasons for delayed wound healing, so that management is appropriate, rapid referrals are made and patient outcomes are optimised. This article discusses some of the reasons why wound healing is complicated in those with diabetes as a comorbidity.

Home care nursing after elective vascular surgery: an opportunity to reduce emergency department visits and hospital readmission

2019 ◽  
Vol 28 (11) ◽  
pp. 901-907 ◽  
Author(s):  
Charles de Mestral ◽  
Ahmed Kayssi ◽  
Mohammed Al-Omran ◽  
Konrad Salata ◽  
Mohamad Anas Hussain ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Home Care ◽  
Vascular Surgery ◽  
Hospital Readmission ◽  
Arterial Disease ◽  
Home Care Nursing ◽  
Peripheral Arterial ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Care Nursing

BackgroundEvents occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research.ObjectiveTo quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission.MethodsPatients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006–2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge.ResultsThe cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario’s 14 administrative health regions (range 16%–84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92.ConclusionHome care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.

P6172Management of silent myocardial ischemia in patients with peripheral arterial disease needing surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Erglis ◽  
G Latkovskis ◽  
D Krievins ◽  
S Jegere ◽  
I Kumsars ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Surgery ◽  
Multidisciplinary Team ◽  
Coronary Stenosis ◽  
Coronary Revascularization ◽  
Arterial Disease ◽  
Silent Myocardial Ischemia ◽  
Team Approach ◽  
Fractional Flow ◽  
Peripheral Arterial

Abstract Background Patients with peripheral arterial disease (PAD) needing surgery have increased risk for post-operative myocardial infarction (MI)/death due to coexisting coronary artery disease (CAD). Coronary CT angiography (CTA)-derived fractional flow reserve (FFRCT) can reliably identify ischemia-producing coronary stenosis in patients with suspected CAD but its value in PAD patients is unknown. Purpose To determine the prevalence of silent coronary ischemia in PAD patients undergoing surgery and to assess the value of FFRCT in guiding management of patients with multisite arterial ischemia. Methods Patients admitted for elective carotid, aortic or peripheral vascular surgery with no cardiac history or CAD symptoms were enrolled in a prospective, open-label, ethics committee-approved study and underwent pre-op CTA and FFRCT evaluation with results available to treating physicians. Ischemia-producing coronary stenosis was defined as FFRCT≤0.80 distal to stenosis in >2mm diameter vessels. Patient management was guided by a multidisciplinary team of cardiologists, cardiovascular surgeons and anaesthesiologists. Primary endpoint was major adverse cardiac events (MACE= cardiac death, MI, urgent revasc) at 30 days with follow up at 3,6,12 months. Results Coronary CTA and FFRCT analysis was performed in 179 consecutive patients (age 66±8 years, male 78%, hypertension 79%, diabetes 10%, dyslipidemia 31%, smoking 37%). CTA revealed extensive coronary calcification (Agatston score 995±1004, range 0–4810) and ≥50% stenosis in 64% of patients. Ischemic coronary stenosis (FFRCT≤0.80) was present in 114 patients (64%) with FFRCT ≤0.75 in 97 (54%) and multivessel ischemia in 63 (35%). Clinically indicated vascular surgery was performed as planned in 170/179 patients (95%) with cardiac anaesthesia and close monitoring and postponed in 9 patients for coronary revascularization (3) or medical/other therapy (6). There were no post-op cardiac complications. Elective coronary angiography, performed 1–3 months post surgery in 86 patients with left main, severe or multivessel ischemia, confirmed significant stenosis in each patient with revascularization in 58 patients (53 PCI and 5 CABG) including 8 for LM disease. There have been no cardiovascular deaths; 3 patients have died of lung cancer which was first discovered on CTA. One patient had peri-procedural MI at time of PCI and one had MI and urgent PCI at 6 months. MACE at 30 days=0/179, 3 months = 1/154, 6 months=2/123, 12 months=0/65. Conclusions Patients undergoing elective PAD surgery have a high prevalence (64%) of unsuspected ischemia-producing coronary stenosis. Pre-op diagnosis with CTA- FFRCT can help guide a multidisciplinary team approach with optimum medical management and staged peripheral and coronary revascularization. Favourable early results are promising and suggest the need for prospective controlled studies to define the role of coronary revascularization in PAD patients. Acknowledgement/Funding Heartflow, Inc.; Mikrotikls Ltd

585 Preventing Occipital Pressure Injuries in Patients Admitted to the Burn ICU

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S134-S135
Author(s):  
Vitina M Kammin ◽  
Kristine Eckert ◽  
Paula Alem ◽  
Margaret A Dimler ◽  
Vitina M Kammin ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Early Identification ◽  
Wound Care ◽  
Tissue Perfusion ◽  
Educational Support ◽  
Skin Breakdown ◽  
Time Out ◽  
Risk Patients ◽  
Improve Patient ◽  
Room Time

Abstract Introduction Occipital pressure injuries (OPI) are categorized as pressure injuries on the occipital bone caused by pressure, shearing, or friction. Patients with significant burns are at a greater risk of developing these types of injuries due to increased fluid volume from resuscitation, decreased tissue perfusion, immobility, edema and length of stay. The rate of OPI in the BICU was 4.3 in 2016; this led to a comprehensive program to reduce/eliminate these injuries. Methods Early identification of at-risk patients and implementation of prevention strategies was conducted. Best practices were reviewed and the following interventions were put into place: on admission, all patients with facial burns, (intubated or not), were given a small size fluidized positioner pillow. The pillow was to be positioned with a defined divot in the center and not flattened (which is the way they were currently being utilized). The fluidized pillow must go into the hydrotherapy room with the patient and the patient’s head turned and repositioned every 2 hours. The use of a moisture-wicking fabric was utilized over the fluidized positioner pillow to prevent maceration. Nursing staff and burn technicians were educated as to practice changes; wound care nurses were available for educational support. In addition, in 2017, the Burn ICU instituted a 2 RN skin check daily for all patients in the hydrotherapy room once all dressings were removed. This tank room “time out” was instituted for early identification of areas of potential skin breakdown. Results Implementation of these protocols has significantly decreased the occurrence of OPI in the BICU. Since implementation, the rate of OPI in 2017, 2018 and Q1 and Q2 of 2019 has been 0%. The application of the fluidized positioner pillow, tank room “time-out” and staff education has greatly decreased the occurrence of OPI in the BICU. Conclusions Patients sustaining large surface area burns and/or full-thickness burns to the head and neck are susceptible to the development of OPI. The utilization of a fluidized positioner pillow in conjunction with improved assessment and identification using a 2 RN “time out” skin assessment daily, has led to a decrease in OPI in our BICU. Applicability of Research to Practice The utilization of the fluidized positioner pillow in conjunction with the described interventions can lead to a decrease in occipital HAPI and improve patient outcomes.

scholarly journals A TEAM APPROACH TO THE IMPLEMENTATION OF THE ANNUAL WELLNESS VISIT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S393-S393
Author(s):  
Lucy Guerra
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Practice Change ◽  
Team Approach ◽  
Change Initiative ◽  
Virtual Training ◽  
Highly Effective ◽  
To Come ◽  
Improve Patient

Abstract The success of any practice change initiative is dependent upon a highly effective team. This presentation will focus on the “secret sauce” of our implementation of the AWV in collaboration with the Dartmouth GWEP. Participating in both asynchronous and live virtual training enabled our team to come together to successfully implement the AWV using a team based model. Using the principles of highly effective teaming and a rapid cycle QI approach we have been able to improve patient outcomes in primary care.

Diagnosis and treatment impacts on wound care efficiency drivers: real-world analysis

2021 ◽  
Vol 30 (7) ◽  
pp. 534-542
Author(s):  
Christina Lindholm ◽  
Tim J Styche ◽  
Helen E Horton
Keyword(s):  
Patient Outcomes ◽  
Real World ◽  
Economic Burden ◽  
Wound Care ◽  
Diagnosis And Treatment ◽  
Wound Management ◽  
Care Pathways ◽  
Care Providers ◽  
Dressing Change ◽  
Improve Patient

Objective: The prevalence and economic burden of wounds are growing. Any wound has the potential to become hard-to-heal and require frequent care. Clinicians need to find ways to absorb demand on services without compromising outcomes. Drivers of wound care efficiency—time-to-heal, frequency of dressing change and the incidence of complications—can be evaluated to shape future wound management. A survey of wound care was conducted by clinicians from five centres in Sweden over a one-week period, during which clinicians documented every wound once. At the time of surveying, 49% of wounds were considered to be improving, infection incidence was 11.7% and dressings were changed a mean of 2.2 times per week, with highly exuding wounds changed 6.9 times per week. The data highlighted the importance of diagnosing patient and wound characteristics in selecting treatments and organising care. Recognised gaps in diagnoses potentially identify opportunities to influence healing, complication incidence and intensity of nursing, thus reducing demand on resources. In conclusion, this survey highlights opportunities to reduce the burdens these drivers present. Through improved diagnosis and alignment to recognised care pathways, there is potential to improve patient outcomes and alleviate the strains placed upon wound care providers.

Achieving effective patient outcomes with PolyMem® Silicone Border

2021 ◽  
Vol 26 (10) ◽  
pp. 498-509
Author(s):  
Linda Rafter ◽  
Mark Rafter
Keyword(s):  
Patient Outcomes ◽  
Chronic Wounds ◽  
Wound Care ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Healing Environment ◽  
Good Patient ◽  
Community Staff ◽  
The Right ◽  
Improve Patient

Clinicians are under increasing pressure to provide high-quality patient outcomes at a reduced cost. Increasingly, community staff must acquire knowledge on advanced wound care products to cope with the growing caseload demands. This article describes the use of PolyMem® dressings to reduce pain, inflammation, oedema and bruising and their ability to debride and absorb exudate while providing an optimum healing environment. The PolyMem range includes multifunctional dressings for various painful chronic wounds. This article also presents five case studies with particularly good patient outcomes where PolyMem dressings were the primary dressing. All five patients were holistically assessed to enable consistent evidence-based treatment decisions. In four cases, the new PolyMem Silicone Border dressing was used. The patients found the PolyMem Silicone Border dressing comfortable and gentle on removal even when the skin was extremely fragile. The right dressing used at the right time on the right patient can improve patient outcomes.

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