Abstract
In Denmark approx. 40,000-50,000 patients are treated annually with chronic wounds. Treatment is time consuming, requiring more resources and different specialities according to their genesis.
At Lillebaelt Hospital, chronic wounds are treated by either orthopedic, vascular consultants or by our multidisciplinary team. Directing the chronic wound patient to the correct speciality to get the right and timely treatment, requires sufficient referral information. The danish referral system allows free text, thus many referrals lack essential information. The goal of the orthopedic-QI-team was to increase the quality of information in chronic wound referrals via APP-based patient engagement prior to the first consultation.
To provide the chronic wound patient with a safe, efficient and smooth patient journey, the referral must contain specific background infomation. Many referrals were lacking basic information and due to this, many patients had to be rescheduled upon arriving at the hospital to be seen by another speciality/team another day. The danish referral system cannot be changed easily, but via app-based-patient-engagement prior to first consultation along with one medical practitioner working systematically, increases the quality of information in chronic wound referrals, thereby improving the quality and efficiency of the first consultation.
All referred patients received a link to the designed app. It was determined that a single doctor would handle all referrals and check the patients' medication status and the answers provided by the app. The app contains 6 multiple choice questions and asks the patient to take 2 pictures of the wound. This allows the doctor to direct the patient to the correct speciality and provide correct facilities and staff saving time and resources, providing timely treatment and a smoother patient journey.
All referrals were graded to show how much relevant information was available prior to the first consultation. This data was plottet in a run chart to show the impact of intervention in phase A and B. The impact on Patient Journey was measured by how many patients needed to be rescheduled in each intervention phase.
Impact on Patient Journey: Why is it important to know if the patient is diabetic? Upon arriving at their initial consultation, 42% need to be rescheduled to be seen by our multidisciplinary diabetic foot care team another day.
6% of the referred patients who lacked information about diabetes did not have diabetes and did not need to be rescheduled.
Impact on Patient Journey: Why is it important to know ""where"" AND ”for how long the patient has had the wound""?
58% of the referrals did not contain enough information in order to plan an x-ray (osteomyelites) prior to the first consultation.
Not all patients used the app initally. A telephone call provided a trigger and engaged the majority. Engaging patients, especially patients with compliance issues, is difficult, but we believe patients can be engaged to supply the information needed to provide a safe and efficient patient journey.