Covid-era Innovation Flourishes Post-pandemic

Dr Michelle Barakat-Johnson used a Sydney Health Partners grant from the Medical Research Future Fund to trial a virtual wound care centre, which combined the use of telehealth and a digital application to treat people with chronic wounds.

Three years later Dr Barakat-Johnson was on hand for the official opening of Australia’s first Wound Care Command Centre at the RPA Virtual Hospital in Camperdown.

She told the launch that the Sydney Health Partners trial proved that a digitally enabled, virtual-based model of care could be successfully used to treat patients with wounds.

“During the COVID-19 pandemic we were able to expand our reach to locked-down wards and patients in their homes, ensuring expert wound care regardless of physical location,” said Dr Barakat-Johnson.

“Inspired by this success, we envisioned a Wound Care Command Centre —a place where every person with a wound receives tailored specialist treatment, through a combination of virtual and in-person visits, unlimited by geographical location.

Patients who have a chronic wound from a pressure injury or venous leg ulcer typically require ongoing community management. Traditionally, when a patient experiences such a wound, they schedule an appointment with their GP, and often face a waiting period before they can receive the necessary care. If they need advice urgently, they might present to Emergency, sometimes unnecessarily.

The Sydney Health Partners clinical trial built on Dr Barakat-Johnson’s initial 2019 research trial of Tissue Analytics - an artificial intelligence-powered wound application developed in the United States.  

The app, which can be loaded onto a phone, uses an image recognition algorithm to analyse photos of wounds taken by the patient or their local clinician. It provides quantitative data on the wound -enabling clinicians to remotely monitor progress - and provide treatment advice.

For the patient, the app provides immediate guidance and support, including reminders to change dressings, without the need for physical visits or long waiting times.

In the Sydney Health Partners trial, Tissue Analytics served as a key point of communication between the patient and a wound consultant based at a hospital. The information was verified by the consultant during regular consultations via video conference and automatically uploaded into the patient’s electronic medical record.

Fifty-one patients – half from Sydney and half from regional or rural NSW – were enrolled over seven months.

The trial proved the viability and acceptability of the model of care, finding that the virtual wound care centre improved patients’ timely access to care, ease of communication with their wound specialist, and self-empowerment to manage their wounds.

The trial found that remote monitoring of wounds did not decrease the quality of care or increase risk to the patient.

The success of the clinical trial led to Therapeutic Goods Administration approval of the new model of care, and its implementation, via RPA Virtual, to serve the whole of Sydney Local Health District.

In January 2023, the Wound Care Command Centre at RPA Virtual began operations, initially serving 50 patients, who were referred by hospitals, Residential Aged Care Facilities and General Practitioners.

The centre is staffed by a Transitional Nurse Practitioner and two Clinical Nurse Consultants who share care with the patient’s GP, treating practitioner or wound care specialist.

Dr Barakat-Johnson says this innovative, multidisciplinary approach has multiple benefits.

“The program brings consistency to chronic wound management by minimising treatment variations and allocating resources efficiently. The shared care approach also empowers patients to play an active role in their own healing process.”

The Wound Care Command Centre allows patients to contact their wound specialist at any time and from anywhere - and access a file that records the chronological progression of their wounds. In addition, the patient's primary carer can use the service to access expert advice.

“It avoids patients being admitted to hospital and enables the earlier discharge of patients into their own home, which can aid their recovery,” said Dr Barakat-Johnson. “The patients also report that the program enhanced their experience and satisfaction with the healthcare system.”

Dr Barakat-Johnson and the team at SLHD are working with a health economist to evaluate the cost-effectiveness of the program, and confirm promising early signs are that it will save money by reducing demand of the hospital system.

By mid-2023, the program had avoided 42 hospital admissions, and for those who were admitted, reduced the length of their hospital stay by between three and five days.

The scale-up of the program includes linking with regional and rural health services, including the Far West and Murrumbidgee Local Health Districts, to reduce gaps in access to specialist wound care and advice.

“Our mission is to provide expert care and advice through in-person or virtual visits, and by using the app,” said Dr Barakat Johnson. “Geographical barriers should never limit access to specialised wound care.”