Transcript
Catherine Milne:
Welcome back to another episode of Wound Conversations, the podcast where wound care professionals come together to learn, share, and advance the practice of healing. I'm Cathy Milne. I am the co-chair of WoundCon and the Clinical Editor of WoundSource. And like our past episodes, we aim to bring you actionable insights from today's leading experts and emerging voices in wound healing, practice management, and even more. Just like with WoundCon and WoundSource, this program is built around the practical concept of “learn today, and apply tomorrow.” Actually, it's “listen today and apply tomorrow.” So in this episode, let's see how we can achieve that in the world of mobile wound care. Whether you're new to wound care or have been in the field of for years, this is a subject matter that we all need to be very familiar with. It is a hot commodity right now in wound care.
We are excited for our guests today to touch on the why of mobile wound care, why it matters, what makes it important right now, and help us understand more about this. We welcome Pamela Scarborough, PT, DPT, MSCWS, FAAWC. Pamela is a good friend. I've known her for years and I'm so happy you could be here today. But let me tell our audience a little bit about you. Dr. Scarborough is the Director of Education and the fellowship program for United Wound Healing, bringing over 40 years of experience across the healthcare continuum. Pamela is a sought after national speaker on wound prevention and management. She is the co-founder of the Wound Certification Prep course, a valued faculty member for WoundCon and SAWC for which I am very grateful, and she has been a contributor to WoundSource. Welcome, Pamela.
Pamela Scarborough:
Thank you, Cathy. Truly, it's a pleasure to be part of this conversation today.
Catherine Milne:
I'm really glad you can come and make the time today. WoundConversations is brought to you by WoundSource, the trusted resource for wound care professionals, and WoundCon, your connection to global virtual education in wound management. So let's get started with the episode. Listen today and apply tomorrow. We like to kick things off by asking our guests about their “wound care why.” So Pamela, what makes you get up every day to go to work? What lights that spark in you? Is there something special in your career or a specific inspiration that has inspired you for all these years?
Pamela Scarborough:
Oh, Cathy. Yes and no. Yes. There is a certain something that started the journey and that was I started my journey out of frustration and I realized that I didn't have the knowledge that I needed to care for patients with these hard-to-heal wounds. At that time, now this is about 1997. I've already been a physical therapist for about 20 years. I'm already 20 years into my career and I decided I needed to do wound care because it wasn't being done well. So PTs (at the time) did not receive formal education and wound management. Most of what we learned regarding wound was done through on-the-job training, and primarily that was whirlpool and sharp debridement, maybe a little collagenase, but there wasn't really structured education on chronic wounds. So I began actively searching for mentors, teachers, courses, and books on wound management. This journey started in 1997.
And honestly, Cathy, it's never stopped. The process of learning this one discipline or any discipline in healthcare is ongoing. And now, at this stage of my career, I'm very grateful to be able to say that I have the opportunity to help educate and mentor others who are entering this profession. So thank you very much for that question, Cathy.
Catherine Milne:
Well, I am so glad you have done that. You have been such an inspiration to a lot of people who have gone through all your courses because I always hear Dr. Pamela Scarborough. She was great. I learned so much for her. And you know what? The thing that people take away from your lectures and your teaching opportunities and your mentoring is that you're very, very practical. So I want to shift a little bit now to mobile wound care. What is it? Why is it so important these days? If I were to say mobile wound care, what does that really mean?
Pamela Scarborough:
All right. What does mobile wound care mean? Question mark, question mark? And that is a great question. So at its core, Cathy, mobile wound care simply means bringing specialized wound management, wound medicine, bringing these services directly to the patient, our resident, rather than requiring them to travel to a clinical hospital. So rather than asking this frail, older adult or homebound patient, our medically complex resident to travel to an outpatient clinic to a hospital, the wound management team brings that expertise to the bedside, whether it's in long-term care, assisted living, rehabilitation, or home health. That's basically what we are. We are a group of people that take this expertise into wherever that patient is living.
Catherine Milne:
So, how did this evolve?
Pamela Scarborough:
When we think about how did it evolve, we're thinking about there had to be pain points. Mobile wound care, so many things come out of pain points and mobile wound management, wound medicine, wound care came out of pain points. There's several things that we want to think about because it solves several challenges that we see across healthcare today. And let's go through a few of these because this is what mobile wound management, wound medicine, wound care does. First, maybe not foremost, but first, it improves access to this specialty, to specialty care. As mentioned, many of our wound patients, they're older, they're medically complex. Most of them have limited mobility or else they'd be able to get to the clinics that they need to get to. So traveling to outpatient wound centers can be difficult. Sometimes those visits simply don't happen because of the complicating factors that prevent transport.
So a lot of people aren't getting their wound care because they can't get to where they need to go to access the professionals who have this skill. So bringing the wound care expertise directly to the bedside helps ensure that these patients are actually seen and treated. So that's the first, access to specialty care. Second, it helps to address the timeliness of care, which Kathy, you know, is a big deal. If we can't get those wounds started, we're not going to be able to prevent them from disintegrating as they go forward. So mobile wound care helps to address the timeliness of care. We know that these wounds worsen when the assessment and treatments are delayed. Mobile providers can evaluate those patients more quickly, intervene earlier, which may help prevent complications such as think wound infections or to treat a local wound infection in that patient's current care setting and sometimes thereby avoiding hospitalizations.
So the third thing that is meaningful about mobile wound care, it supports the clinical teams that are already caring for the patients. Think about these nurses. In these long-term care and assisted living settings, they are working so hard just to manage these complex issues. And you add a wound on top of that and oh my, they are overwhelmed. The whole system practically disintegrates when we try to put too many things on people who don't have the specialty training for doing this. So having a wound specialist comes into the facility, creates this collaboration among the caregivers. Our wound care providers, and I didn't mention that I work right now for United Wound Healing, which is a mobile group. And when our providers go in, they become part of the team in the building and they literally lead the wound management team in the building. So this is expertise.
It's not just clinical expertise. It's also clinical leadership that is brought into the building to help with the collaboration. And then the providers that come in, they help with the education and they support the opportunities for the facility teams to be better for having the wound provider groups in their building with them. And finally, when we have our wound management groups in the buildings, it helps with the continuity of care. The same wound team, even if Kathy say that you had a virus of some kind and you couldn't go, you have other people that you could call and you can tell them, "This is the patient. I can't see them right now, but could you see them?" And you would give them the information. If one of our providers can't go, another provider in our group that has access to that information gets that information so that we can have better continuity of care as that patient's condition changes in real time.
So those are four really good reasons for why this care continuity situation is so important.
Catherine Milne:
Very good. So I actually have to talk a little bit something about you said that was really important. So meeting the patient where they are is very important. If you work in a wound clinic or if you work in the hospital and your patient comes in with cellulitis, you can never see that environment that they were in. You have no idea what the contributing factors are. I'm sure you've done enough in your life where I've gone into patient's home and I see their recliner chair and where they're elevating their legs, where they rest their legs is full of dog hair and cat hair and human hair and you don't see that when the patient comes to you.
Do you have any examples from your practice or from a provider in your practice about how mobile wound care has changed their trajectory?
Pamela Scarborough:
There's a specific patient that comes to mind and this patient, she's a grandmother who developed a wound, a significant wound, but was able to receive her treatment through mobile wound care in her home. But what struck me was not just the wound care itself. It was her environment where she was surrounded by her family, by her routines, by the people who loved her. Instead of being transferred in and or out of hospitals or clinics, the wound care team came to her. So the wound was treated, of course, but what really mattered, what mattered to the grandmother was that she was able to stay where she felt safe and supported. Her family could participate in the care and ask questions and be part of that healing process. So Cathy, this situation is truly repeated over and over and over with mobile wound care groups or any other type of mobile group.
And this is one of the things that's so important is that we are taking care of these people where they are and their environment is also contributing to their healing trajectory.
Catherine Milne:
So not only impacting the patient where they are, I see mobile providers actually impacting their colleagues at the bedside because when they're there, they're not just assessing the patient, doing their notes and leaving. They're explaining things to either the caregivers or the providers or the family because it's not just one time you do something that makes the patient better. It has to be consistent throughout the patient's wound episode. When I look at it, it's every provider's trying to get themselves out of a job.
Pamela Scarborough:
That's right. That's exactly right. If you're a wound provider, you're trying to get yourself out of that particular wound. You got it.
Catherine Milne:
That's correct. And also, but it also applies to other wounds because that provider's taught their colleagues. So they intervene earlier and then the wound provider gets called earlier and there's a better supply chain, so to speak, because the providers or the caregivers know, "Oh, I'm going to need compression. I better order it now." So let's say you are the boss and you're a boss of a mobile provider group. What kind of people do you try to hire?
Pamela Scarborough:
People that want to learn, first of all, that are open to learning. No matter where they came from, they have to be open to learning a new discipline. They can be a surgeon. This is not a surgeon's job. Chronic wound care is not a surgeon's job. You're so knowledgeable, but you're not a wound care clinician. Two different arms of healthcare. So if you're a surgeon and you're coming to us and you wanted to do this, or say you're a family practice physician or a nurse practitioner or physician associate, when you come to us, we have to understand and you have to understand that you have an open mind to learning from the basics. So that's number one. They have to learn. We have to be humble and kind when we get to this point. That's one of the most important things is that. And then they have to like this kind of work because when you're looking at mobile, any kind of care, be it home health.
I was a home health director of rehab for home health, PT/OT/ST. Loved it, but there's certain qualities that you have to have to do this successfully. And would you like me to talk about those a little bit, Cathy? So what we're asking kind of sort of is why would this model of care be appealing to clinicians? Why might they want to even do this? So what I think, what Pamela thinks is that the mobile wound care model, be it wound management, total joint rehab or other etiologies, can be cared for in a form of mobile healthcare. And it's attractive to clinicians, I think, for several reasons. First of all, it allows clinicians to practice in a very patient-centered way. When you see someone in their own home or their care environment, wherever it may be, you understand much more, just to your point about that chair.
How clean is it? How dirty is it? Do they have access to everything? So you understand more about their daily life, their support system, and the challenges that they face in that environment. So that perspective often leads to more practical and individualized care. Second, mobile care often allows clinicians to focus on one patient at a time. If you've ever been in an outpatient wound clinic or if you've ever worked in a clinic of any kind, you have a clock ticking every single second, and there's not a lot of wiggle room. So you can focus on one patient, which many of us find professionally satisfying. It creates a space for us to listen to the patient and the family, to assess carefully, to educate the patients and the caregivers, to your point, Cathy, talking about educating these people without the time pressure that can exist in a busy setting for other care settings.
And another reason, what I love is professional autonomy. In mobile practices, clinicians rely heavily on their clinical judgment and problem solving skills in real time. And many providers enjoy this level of independence and while still collaborating with the broader healthcare team, and I learned this from home health. I want to always be doing more than one thing at a time. And this mobile care setting, home health, did that for me, and it gave me the autonomy where I could thrive. So mobile wound care is very similar to that, creating that autonomy. And finally, many clinicians simply enjoy the variety and the movement that comes with this type of practice. Instead of sitting in the same clinic all day, they're moving between care settings, between different patients, and seeing healthcare delivered in real life rather than just in a clinical environment.
So for many clinicians, that combination, the patient connection, the autonomy, and the variety makes mobile care a very rewarding model of care.
Catherine Milne:
Is there anything a mobile provider can't do in a offsite setting?
Pamela Scarborough:
Anything they can't do. Well, we have to stay within our scope of practice, whatever that might be. So we have to follow. Our license is the law. It's not a suggestion. So we have to start there. Is there anything they can't do? They're qualified to do it. They have the equipment, they have the supplies. It's within their licensure. The only thing they can't do is what they shouldn't do. When you do your assessment, when you do your evaluations, when you write your care plan, you make sure that you've looked at every single thing and you don't just look at the hole in the patient and you don't call Pamela and say, "What dressings should I use?" Because the first thing I'm going to ask you is to tell me everything about that patient's physical condition before I'm going to even talk to you about addressing.
Catherine Milne:
I'm really glad that you brought that up because I think I'm going to ask you in a minute about one of your favorite tips, but you already gave a tip, so now you're going to get to give another one. And the tip you just said is just because you can do something doesn't mean you should do something. So excellent, excellent practical pearl. So before we wrap up today, would you share a mobile wound management "wound to the wise" with us? This is a well-known term that we use in WoundCon. This could be a tip, a Pearl, something you've picked up along the way that you can share with other wound healers so they too can incorporate that into their practice.
Pamela Scarborough:
Thank you, Cathy, for that. I'm going to stay in our theme here, and I love this phrase wound to the wise. I truly love it. So my wound to the wise, it would be this. Sometimes the most powerful intervention we can provide is delivering good medicine without disrupting that patient's life. And mobile wound care allows us to bring that expertise to the patient while preserving the environment and support system that often contribute just as much to healing as any dressing or treatment we provide. So as clinicians, that's a powerful reminder that healing is not just about the wound, it's about the whole person and the people around them.
Catherine Milne:
I do want to thank you so much, Pamela, for joining us today, and thank you to the audience for tuning in. Our next episode is going to be hosted by Dr. Jay Shah, and this will focus on caring for the caregiver. And soon after, we'll meet back here with Dr. Scarborough to talk more about the day-to-day realities of mobile wound care management. Until then, make sure you browse the content available on woundsource.com and the accredited education opportunities available for WoundCom. Of particular interest, HMP Global is hosting a virtual mobile wound management series with the next installment taking place on May 15th. If you haven't seen the first one, you definitely want to see the next one. You can register for that series by going to https://tinyurl.com/4NUZ85X4. I think we should put that on the screen if we had one. It is free to register and offers continuing education credits.
Just go to HMP Education and type in mobile wound management and you'll get that link. You'll be able to find this and future episodes on woundcon.com, SoundCloud, Apple Podcasts, or Spotify. So be sure to follow us on your favorite platform. Keep following along as we listen today and apply tomorrow. Thank you very much for joining us today.
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