CARES4WOUNDS is Beneficial for Chronic Wound Management – Wounds Asia Journal

A study conducted on CARES4WOUNDS (C4W) by St Luke’s Hospital (SLH) was published in the Wounds Asia Journal. This is a dedicated online wound care journal providing educational resources that also acts as a forum for clinicians to share and discuss their experiences and practices. In this study, SLH reviewed the effectiveness of the C4W application in managing chronic wounds in nursing homes over 2 months. 

Chronic wounds are defined as wounds where healing is impaired and does not occur in a timely and organised manner due to a variety of reasons, including inadequate vascularity and innervation (Golinko et al, 2009). In Singapore, data from public primary care clinics and tertiary hospitals have revealed an increase in the prevalence of chronic wounds in the last few years. A recent study recorded a 95.1% increase in wound-related hospital admissions from 2013 to 2017, contributed to by increases in the prevalence of neuroischaemic ulcers and pressure ulcers (PU) (Lo et al, 2020). The clinical and financial strain on Singapore’s healthcare system has escalated as a result, proven by a study which estimated the gross direct cost of chronic wounds to each patient to be SGD $9532 (Tan et al, 2016). 

In nursing homes, patients are more likely to get chronic wounds due to their multiple comorbidities and reduced mobility. The nursing home staff are capable of performing basic wound care and dressing, however, they still require the wound assessments by specially-trained wound nurses and doctors to determine the types of dressings necessary or the need for additional wound management. Hence SLH designed the study to evaluate the outcomes of wound assessments using C4W application on a intervention group and compared it against a control group manually managed by wound care nurses in nursing home settings.

Outcome 1: 2X Improvements in Falanga Score

The Falanga Score is a clinical tool used to categorise wound beds according to the degree of granulation, the amount of exudate and oedema, and the condition of the epidermis. It is helpful not only in the evaluation but also in making predictions on the eventual healing outcome of the wounds. Each evaluated parameter receives a score, with a maximum possible score of 16 for each wound. For each additional unit, the chance of healing is noted to rise by 22.8% (Falanga et al, 2006).

By the end of the 2-month period, all 7 patients in our pilot trial had improved Falanga scores. 

Outcome 2:  265% Decrease in Time Taken

The amount of time spent reviewing each patient over the 2-month period in the intervention group was reduced by 265% compared to the control group. This meant significant time savings and increased productivity for the wound clinicians. The use of C4W had also enabled fewer face to face reviews by wound clinicians and decreased travelling time. These time savings translated to cost savings as seen in Outcome 3.

Outcome 3: Over 60% Reduction in Overall Costs

The overall cost incurred per patient was also reduced by over 60%, providing cost-savings for the nursing homes with shorter consultation and travel time spent on each patient by wound clinicians. 

Overall, it was concluded that applications like C4W have the potential to be a useful tool in the management of chronic wounds. This is especially beneficial given that specially-trained wound nurses will be required to manage more and more chronic wounds in the community setting.

For more information on the cost-benefit analysis of C4W conducted by SLH, please read this journal article for full details.