ASK THE EXPERT: MARTHA R. KELSO
ASK THE EXPERT
Martha R. Kelso, RN, CHWS, HBOT, is the Chief Executive Officer of Wound Care Plus, LLC, the Midwest’s largest mobile wound care provider headquartered in Blue Springs, Missouri. Wound Care Plus, LLC actively operates in Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Minnesota, Missouri, Nebraska, New Mexico, New York, Ohio, Oklahoma, South Carolina, South Dakota, Texas, and Wisconsin. With over 25 years of experience in advanced wound care, Kelso is a visionary and entrepreneur in the field of mobile medicine.
KI: Can you list where you operate and administer mobile health? And please describe the most significant challenges you face in a post-acute care setting.
MK: We currently operate and practice in the following places of service/sites of care: skilled nursing facilities (SNFs)/long-term care (LTC) communities, assisted living facilities (ALFs), custodial care facilities, group homes, physician offices, homes, in-patient hospitals, long-term acute care hospitals (LTACHs), outpatient wound centers, intermediate care facilities, comprehensive inpatient rehab facilities (IRFs), rural health clinics, prison or correctional facilities, and telehealth when needed. Most of the time, we practice in Post-Acute Care communities/facilities.
There are certainly some significant challenges in the post-acute care setting that we deal with. The most significant factors are diagnosing and treating the nation’s retired and under-served. This group is the most aged, has a litany of co-morbid medical conditions, and polypharmacy is rampant while also dealing with cognitive impairment and fear of invasive studies (poking and prodding). These factors complicate wound healing and create wound chronicity, compounding the wound even further.
Atherosclerosis, venous disease, and microvascular circulation disorders all increase with age. Unfortunately, none of these conditions get better with time. Additionally, access to real-time diagnostic studies for wound care is virtually non-existent. Fees associated with obtaining diagnostic studies are enormous, like transportation, the cost of a staff member to travel with the resident, hospital fees, and physician fees, not to mention the hours it can take to obtain one study.
KI: Explain what your term “trunk-to-bed” technology means.
MK: Trunk-to-bed technologies are portable, handheld, non-invasive diagnostic devices that allow the Wound Care Plus providers to deploy quickly and easily to treat multiple patients and travel to various locations in a day. If a medical device is 75 pounds, it’s not possible, safe, or logical for providers to continually heft it in and out of the back of a vehicle.
Unlike some cumbersome devices on the market, SnapshotNIR has allowed our specialists to move freely and efficiently. Images can be obtained in seconds and are repeatable, not to mention the camera is easy to use. It doesn’t require squeezing a leg or poking and prodding and there is no contact with the wound or ulcer.
KI: We know delaying sharp debridement can stall wound healing and encourage bacterial growth in non-viable tissue. How do you use SnapshotNIR to ensure that a debridement will be a safe and effective treatment?
MK: Sharp debridement may be contraindicated for numerous wound types until adequate blood flow is established or confirmed. That includes palliative wounds, diabetic wounds, arterial wounds, mixed etiology wounds of the lower extremities, malignant wounds, and flaps or grafts.
The images captured on SnapshotNIR have allowed our providers to see below the surface and confirm that some patients had sufficient circulation and were candidates for sharp debridement. Previously, the belief was that most elderly patients had mixed arterial venous disease and debridement should be avoided. SnapshotNIR proved in numerous cases that we could provide sharp debridement, and based on the results of the device, sharp debridement was needed more often.
KI: Since adopting Snapshot into your wound care arsenal, you’ve collected some very interesting data on how oxygenation imaging has impacted your treatment plans. Can you share some of those insights?
The data has been powerful and influential in our decision-making and treatment processes. Results of an imaging study of the microcirculation and oxygenation impacted treatment plans in two compelling ways: we could determine the perfusion area was adequate 85% of the time, which was a significant change. Previously, we felt confident their perfusion was adequate only about 15-20% of the time.
Secondly, the need for additional blood flow studies was reduced to 7.4% of the time, meaning we are saving payor dollars, saving facilities or insurance payors transportation costs, and saving patients time transporting to and from various care locations. The additional diagnostic studies are now not medically necessary.
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