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ORIGINAL ARTICLE
The viability and acceptability of a Virtual Wound Care
Command Centre in Australia
Michelle Barakat-Johnson
1,2,3,4
| Badia Kita
1,2
| Aaron Jones
1,5,6
|
Mitchell Burger
5,6,7,8
| David Airey
9
| John Stephenson
10,11
| Thomas Leong
12
|
Jana Pinkova
12
| Georgina Frank
13
| Natalie Ko
14
| Andrea Kirk
15
|
Astrid Frotjold
2
| Kate White
1,2,16
| Fiona Coyer
3,4,11,17
1
Department of Nursing and Midwifery Executive Services, Sydney Local Health District, Sydney, New South Wales, Australia
2
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
3
School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
4
Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
5
Health Informatics Unit, Sydney Local Health District, Sydney, New South Wales, Australia
6
Discipline of Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
7
Information Communication Technology, Strategy Architecture and Innovation, Sydney Local Health District, Sydney, New South Wales, Australia
8
School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
9
Riverina Endovascular, Wagga Wagga, New South Wales, Australia
10
Biomedical Statistics, School of Human and Health Services, University of Huddersfield, Huddersfield, United Kingdom
11
Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
12
Nursing and Midwifery Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
13
Podiatry Department, Sydney Local Health District, Sydney, New South Wales, Australia
14
Department of Nursing and Midwifery, Concord Hospital, Sydney, New South Wales, Australia
15
Nursing and Midwifery Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
16
The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, New South Wales, Australia
17
Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
Correspondence
Associate Professor Michelle Barakat-
Johnson, Patient Safety and Quality Unit,
Level 7 King George V Building, Royal
Prince Alfred Hospital, Missenden Road,
Camperdown, NSW 2050, Australia.
Email: michelle.barakatjohnson@health.
nsw.gov.au
Funding information
Sydney Health Partners; Rapid Applied
Research Translation (RART) initiative
Round 3; Medical Research Future Fund
(MRFF)
Abstract
The objective of this study was to assess the viability and acceptability of an
innovative Virtual Wound Care Command Centre where patients in the com-
munity, and their treating clinicians, have access to an expert wound specialist
service that comprises a digitally enabled application for wound analysis,
decision-making, remote consultation, and monitoring. Fifty-one patients with
chronic wounds from 9 centres, encompassing hospital services, outpatient
clinics, and community nurses in one metropolitan and rural state in Australia,
were enrolled and a total of 61 wounds were analysed over 7 months. Patients
received, on average, an occasion of service every 4.4 days, with direct queries
responded to in a median time of 1.5 hours. During the study period,
Received: 23 December 2021 Revised: 18 February 2022 Accepted: 21 February 2022
DOI: 10.1111/iwj.13782
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2022 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.
Int Wound J. 2022;19:1769–1785. wileyonlinelibrary.com/journal/iwj 1769
26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI:
56-88) days. All patients reported high satisfaction with their wound care,
86.4% of patients recommended the Virtual Wound Care Command Centre
with 84.1% of patients reporting the digital wound application as easy to use.
Potential mean travel savings of $99.65 for rural patients per visit were
recognised. The data revealed that the Virtual Wound Care Command Centre
was a viable and acceptable patient-centred expert wound consultation service
for chronic wound patients in the community.
KEYWORDS
chronic wounds, digital wound application, telehealth, virtual care, wound care
Key Messages
•Translating the use of a digital wound application platform to provide effec-
tive wound care through a new virtual model of care is critical to improving
access and a continuum of evidence-based care to patients with chronic
wounds.
•The aim of this study was to evaluate the viability and acceptability of a Vir-
tual Wound Care Command Centre utilising a digital wound application
platform across four specialities in metropolitan and rural services in one
state in Australia.
•All patients reported a high degree of satisfaction with the Virtual Wound
Care Command Centre in relation to direct and ongoing access to specialist
care, monitoring, improved confidence, and reduced travel time and
savings.
•Remote monitoring of wounds did not decrease the quality of, or access to,
care; it yielded a median clinician-to-patient response time of 1.5 hours for
wound triage and care plan development.
1|INTRODUCTION
Living with a chronic wound carries significant
unrecognised burden that impacts the individual, their
family, and health care utilisation. The presence of a
chronic wound is associated with increased length of hos-
pital stay,
1,2
higher risk of infection,
3
and increased
readmissions within 30 days due to wound complica-
tions
2
; leading to poor health-related quality of life. An
Australian qualitative study of 25 patients with chronic
wounds in the community found chronic wounds
impacted a person's physical mobility, finances, and abil-
ity to maintain work.
4
In addition, a cross sectional study
of 222 patients with chronic wounds in New York rev-
ealed that moderate to severe depression was experienced
by patients with wounds beyond 3 months.
5
It is estimated that 345 000 people in Australia live
with chronic wounds, costing the health care system
$2.85 billion annually.
6
More recent data suggests that
chronic wound incidence and prevalence are under-
reported in Australia, largely due to different types of
wounds being reported in specific populations and the
wide variations in reporting.
7
In the United Kingdom, an
estimated 2.2 million chronic wounds are managed by
the United Kingdom's National Health Service every
year.
8
Chronic wounds are reported to affect 2% of the
population in the United States.
9
Current standard wound care in Australia is complex,
with lack of standardisation in wound assessment, inter-
ventions, and clear clinical pathways, in addition to,
uncoordinated services with poor communication,
3
lengthy delays between specialist appointments,
3
and
inequitable access to quality wound products.
10
Medical
record systems are also inadequate for documenting
wound data, with existing systems not designed to track
or store wound images or generate wound reports and
patient confidentiality is potentially breeched when clini-
cians take images on personal devices.
11
These factors
contribute to poor wound-healing outcomes in Australia
and support a case to create more patient-centred models
of care in the community for patients with chronic
wounds.
1770 BARAKAT-JOHNSON ET AL.
The recent experience of the COVID-19 pandemic in
our health service required transition, where possible, to a
telehealth model of care (MoC), reducing risks to patient
by limiting face-to-face contact in clinical settings. For the
individual with a chronic wound, this was not feasible,
leading the authors to establish point of care access to spe-
cialist services via a virtual wound MoC with complemen-
tary digital services for patients with chronic wounds.
Virtual care (a broader term for telehealth or telemedi-
cine) is a MoC that offers a wide range of digital services
that assist in delivering care to people remotely.
12
It
includes the use of telephones, video conferencing, moni-
toring, and store-and-forward communication platforms.
Studies on virtual care models for patients with
chronic wounds are limited. From the few available stud-
ies on patients with chronic wounds and quality of life
outcomes, virtual care has been demonstrated to be safe
and effective in wound-healing, improving access to care
and confidence in patients.
13-15
A recent systematic
review conducted by Huang and colleagues
14
summarised the evidence available and assessed the effi-
cacy of telemedicine for chronic wound care across
14 randomised control trials. The researchers found tele-
medicine had a positive effect on chronic wound out-
comes as it facilitated wound-healing and reduced
adverse events when compared to usual care. Chen and
colleagues'
13
systematic review of 58 studies evaluated
the efficacy and safety of telehealth in chronic wound
care. They found that the available evidence demon-
strated telehealth to have similar wound-healing efficacy
and safety when compared to face-to-face care.
The New South Wales (NSW) Virtual Care Strategy
(2021-2026) published by NSW Health sets out a plan to
support all health services to develop local telehealth
strategies and virtual MoCs. The aim is to achieve acces-
sible and efficient quality of care for patients irrespective
of where they live. To do this, virtual care services must
complement face-to-face care.
16
In our health service of four hospitals and five com-
munity centres, a virtual care service for remote patient
monitoring was launched in 2020 to provide additional
pathway of care between primary care providers, individ-
uals, and tertiary centres, where this model provides an
opportunity to improve patient centred care. The virtual
care service caters for (a) people in the community who
are immune-suppressed; (b) mental health patients;
(c) patients of the fracture clinic; and (d) COVID-19
patients in home isolation.
17,18
Almost 4000 people were
cared for in the first year of its launch with patients
reporting a high degree of satisfaction, particularly in
relation to being monitored virtually, increased confi-
dence in their own care, and improved access to specialist
services.
19
Our previous study,
20
conducted in one health ser-
vice in Australia, tested the acceptability and effective-
ness of the Tissue Analytics™digital wound
application (digital app)
21
among clinicians. The study
found that the digital app improved documentation and
data management of wound care. Clinicians found the
application was easy to use, assisted with objective
wound assessment, and provided benefits by improving
connectivity and continuity of care for patients in the
community. The study identified an opportunity for
further research into the feasibility of utilising a digital
wound application to establish a new virtual service
that would provide remote access to specialist wound
care for individuals with wounds, specifically chronic
or complex wounds. This article presents the findings
from a translational study on the viability and accept-
ability of utilising the digital app in a Virtual Wound
Care Command Centre (eWCC); a new MoC to
improve wound care for individuals in the community
across four specialties: vascular, podiatry, specialist
wound services, and community nursing in metropoli-
tan and rural NSW.
2|MATERIALS AND METHODS
2.1 |Study design
This was a prospective, observational study to test the
viability and acceptability of an eWCC supported by a
digital application, namely Tissue Analytics™
(Baltimore, Maryland, https://www.tissue-analytics.com).
Tissue Analytics™is a purpose-designed digital wound
management platform that provides tools to record,
track, and analyse patient wounds,
21
and is referred to as
the ‘digital app’from this point forward. Participants
were recruited to the study between 17 December 2020
and 28 May 2021, and wound data were collected until
the wound healed or end of data collection on 6
August 2021.
2.2 |Study setting
The study was undertaken across four different specialities
(nine centres) in metropolitan and rural health services in
one state, NSW, in Australia that provides services to
patients with wounds. The specialties include podiatry and
vascular outpatient clinics, general community nursing,
and specialised wound services such as vascular and endo-
vascular surgery. There were 19 wound specialists (nurse
specialists, podiatrists, doctors, surgeons) across the nine
centres who were responsible for enrolling and monitoring
BARAKAT-JOHNSON ET AL.1771
patients in the eWCC. A shared care plan was developed
between the wound specialist and treating general practi-
tioner (GP) or community nurse.
2.3 |Participants and recruitment
Participants with a wound(s) and ≥18 years of age were
invited to participate in the study. Participants were
excluded if they had: (a) a non-healing wound (eg, pallia-
tive, malignant, or fungating tumours; wounds with a
blind-ended track such as pilonidal sinus and sinus);
(b) a wound that required specialised treatments such as
a burn; or (c) a superficial, fast healing wound that
requires <1 week for wound closure.
2.4 |Standard usual care
Patients with wounds discharged from hospital who are
referred to community nursing are triaged and on aver-
age, if not urgent, are seen within 2 weeks. If the wound
FIGURE 1 Tissue Analytics™digital wound application platform comprising of a (a) clinician mobile phone interface, (b) clinician web
portal interface, and (c) patient mobile phone interface
1772 BARAKAT-JOHNSON ET AL.
is complex or not healing, the community nurse will
request a joint visit with a specialist wound nurse. Special-
ist wound nurses are only available through direct referral
from clinicians. Further, patients are unable to call or
email specialist wound nurses for quick access. Patients
who have follow up with their treating GP or an outpa-
tient clinic or follow-up with a surgeon experience long
waiting periods between visits as they must either wait for
their appointment to see their treating clinician, or they
wait for the treating clinician to make a visit—the latter
for patients with mobility difficulties. In all cases, patients
experience delays in receiving specialised wound services.
2.5 |Intervention—The Virtual Wound
Care Command Centre
The eWCC is an interdisciplinary nurse-led specialist care
and support service, available to patients and their treating
GP or nurse, which enables the application of treatment
plans for people with chronic wounds in the community.
The eWCC comprises: (a) coordinated services of advanced
wound specialists accessible to the patient, their carer, or
treating nurse/GP; (b) continuity of care for patients who
are discharged from hospital, into the community; (c) a
comprehensive treatment plan by the wound specialists;
(d) a purpose-designed digital app with real-time imaging
of wounds
21
comprising a patient interface and a clinician
interface (Figure 1); (e) audiovisual communication con-
nection to a command centre for the patient to allow
prompt access/response for the treating clinicians (wound
specialists, treating nurse/GP) or patient/carer to ensure
early recognition of deterioration; and (f) a centralised
database for benchmarking and generating reports. Patients
are supported by their treating clinicians and instructed on
what to do in an emergency. Patients are also handed an
instructional information brochure with clinician contact
details should either technical or clinical issues arise. As
such, the use of the digital app did not replace required visi-
tations to the treating clinicians but complemented these
visits by providing additional support in between appoint-
ments. Lastly, there is a secure messaging function within
the digital app for communication between the patient and
the treating clinicians.
2.6 |Outcome measures
The primary outcome was the viability and acceptability
of the eWCC, patient usability of the digital app, and effi-
cacy of remotely monitoring wound care. Other outcomes
included number of wounds healed (defined as the epi-
thelial tissue covering 100% of the wound), wound-
healing rate, and potential travel-related time and cost
savings, and carbon footprint avoided.
2.7 |Study procedure
Wound specialists (nurse specialists, podiatrists, doctors,
surgeons) in the study units were trained to use the digital
app. Training consisted of two sessions: one for the clinician
interface and web portal, and one for the patient interface.
The wound specialists assessed patients for eligibility and
enrolled them in the study as participants. Informed written
consent was obtained from patients prior to enrolment. Par-
ticipants were trained by their wound specialist to down-
load and use the patient interface of the digital app. They
were provided with a written information sheet and the
contact details of their wound specialists for questions.
For enrolment, the wound specialists added the par-
ticipant as a user in the digital app system by entering
their details, taking an image of the wound, and inserting
wound information into the digital platform using the cli-
nician interface of the app. The participant would then
use the app to take successive images of their wound and
enter wound characteristics such as pain and ooze. When
participants used the digital app to photograph their
wound and input wound information, their wound spe-
cialist received a notification to review the report and tri-
age as appropriate. The wound specialists would then
enter data on the treatment plan and respond to the par-
ticipant. In this way, the digital app was used as a tool to
support remote wound care assessment and manage-
ment. As this study was an observational study, the digi-
tal app was not integrated with the electronic medical
record (eMR). Instead, wound documentation was gener-
ated into a PDF document and uploaded into the
patient's eMR to maintain record keeping.
Participants enrolled in the eWCC were invited by
their wound specialist at the first consultation and last
consultation to complete a survey on their satisfaction
with the wound care they received. The surveys were
conducted anonymously and completed on paper or via a
survey link. They were also invited to participate in an
interview to share their views and experiences of wound
care via the eWCC and digital app. Interviews were con-
ducted via phone by one of the researchers and lasted
approximately 15 minutes.
2.8 |Data collection
Each participant was assigned a unique identifier to ensure
patient confidentiality during data collection and analysis
of de-indentified data. Re-identifiable coded data were
BARAKAT-JOHNSON ET AL.1773
stored on the University of Sydney's secure online REDCap
(Research Electronic Data Capture) database,
22,23
accessible
only to the study investigators. REDCap is a secure, web-
based software platform designed to support data capture
for research studies, providing (a) an intuitive interface for
validated data capture; (b) audit trails for tracking data
manipulation and export procedures; (c) automated export
procedures for seamless data downloads to common statis-
tical packages; and (d) procedures for data integration and
interoperability with external sources.
2.8.1 | The Virtual Wound Care Command
Centre Occasions of Service
The occasions of service (OOS) administered by the
eWCC were collected by the digital app platform. An
occasion of service is defined as any examination, consul-
tation, treatment, or other service provided by a clinician
in a non-admitted setting to a client/patient. Each wound
image and text note communicated using the digital app
platform was counted as an OOS.
2.8.2 | Participant surveys
Two participant surveys were administered. The first sur-
vey administered at the beginning of the study to capture
participant satisfaction with their wound care under stan-
dard usual care practices and the survey was repeated at
the end of the study to capture participant satisfaction
with their care through the eWCC. To capture usability
and acceptability of the digital app, a second survey com-
prising of 12 questions were added to the first survey and
was administered at the end of the study. This second sur-
vey was based on a telehealth satisfaction instrument
developed by Fatehi and colleagues.
24
The survey ques-
tions were constructed using a five-point Likert scale,
including the options: strongly disagree (scoring 1 point);
disagree (scoring 2 points); neither agree nor disagree
(scoring 3 points); agree (scoring 4 points); and strongly
agree (scoring 5 points). They were piloted with two con-
sumers on the research team, prior to finalising the sur-
vey. Surveys were kept anonymous. All surveys were
captured using the REDCap electronic data capture tools
hosted at the University of Sydney.
22,23
2.8.3 | Participant interviews
Participant interviews continued until data saturation was
reached at 10 interviews. The interviewers asked the partic-
ipant to express their overall experience with virtual wound
care and the digital app, prompting them to highlight
things they liked or did not like and how it affected their
wound care. The interviews were recorded using either
Windows Media Player or Apple Voice Memos and the
recordings were transcribed verbatim by Digital and Audio
Transcription Services (DAATS, Australia).
2.8.4 | Wound data
Characteristics of wounds, including wound type, wound
size, and change in wound characteristics over time, were
captured and downloaded from the digital app. All partic-
ipants' wound data were de-identified when recorded and
entered into REDCap.
22,23
2.8.5 | Impact on travel
At the end of the study, participants were asked about their
mode of transportation to estimate travel distance, time,
and fuel costs. The Green Vehicle Guide (https://www.
greenvehicleguide.gov.au/) was used to collect data on the
vehicle'sfuelconsumptionandfuelemissions.Costoffuel
was determined using NRMA fuel report data for NSW
(https://www.mynrma.com.au/membership/my-nrma-app/
fuel-resources/weekly-report/). For participants who com-
muted by public transport or used commercial passenger
vehicles, the average fare cost for a trip was recorded. Travel
time and distance were estimated using Google Maps.
2.9 |Data analysis
2.9.1 | Occasions of service
The number of OOS per participant was recorded and
tabulated against their duration of enrolment. Linear
regression was conducted to determine the average OOS
frequency per participant.
The digital app recorded the date and time of all images
and text communications. From this data, the response
time was calculated to assess the efficiency in using the digi-
tal app as a mode of communication between the wound
specialist and patient participant. The response time is
defined as the time between communication events involv-
ing the participant and their wound specialist.
2.9.2 | Participant surveys
Questions from the surveys were grouped into five cate-
gories. Survey outcomes were calculated by adding the
1774 BARAKAT-JOHNSON ET AL.
scores of each question of the survey and then calculating
the mean score of each category. The percentage of
responses for each Likert scale value for the questions in
each category was also graphed for analysis. Comparison
in satisfaction survey scores was used to assess partici-
pant experience with the eWCC compared to the usual
care they had previously experienced. Survey scores for
the digital app were used to assess participant usability
and acceptability of the digital app.
2.9.3 | Patient interviews
Interviews were analysed using Braun and Clarke's guid-
ance. Thematic analysis
25
was conducted in six steps:
familiarisation with data; generation of initial codes; sea-
rch for themes; review of themes; definition and naming
of themes; and preparation of a written report. Data anal-
ysis was undertaken by three team members (M.B.J.,
B.K., K.W.) independently to ensure rigour.
2.9.4 | Wound data
Percentage change in wound surface area (SA) for each
participant's wound was calculated using the difference in
wound SA evaluated from date of enrolment to last wound
evaluation date for the participant. Healing rate was
expressed as the advance of the wound margin towards
the wound centre per day, as this calculation allows com-
parison of healing rates between wounds independent of
initial wound size or shape; using the calculation below.
26
Healing rate
¼2 final area initial areaðÞ
final perime ter initial perimeterðÞno:of daysðÞ
For wounds decreasing in size, the healing rate is a posi-
tive value, while a negative value was given to those
wounds that increased in size.
2.9.5 | Impact on travel
Cost of travel for participants using private vehicles was
calculated using the fuel consumption data of the vehi-
cle (L/km), the distance travelled (km), and average
fuel cost of AUD1.346/L over the period of the study.
For participants who commuted by public transport or
used commercial passenger vehicles, cost of travel was
calculated as the average fare cost. Mean travel time
was calculated by averaging the minimum and maxi-
mum travel times provided by Google Maps at 9 AM,
12 PM, and 3 PM. Fuel emissions were calculated using
the CO
2
emissions data (g/km) for each vehicle and the
distance travelled (km). Carbon footprint was deter-
mined using the estimation that one mature tree offsets
on average 0.0029 t carbon dioxide per year (https://
trees.org/carboncalculator/).
All data were entered into GraphPad Prism (v9.2.0).
As an acceptability and viability study, no a priori sample
size calculation was conducted. Convenience sampling
was used for patient sampling. Patient demographic and
clinical data were analysed descriptively using frequen-
cies and percentages (for categorical measures), and
means and SDs (for numerical measures).
Inferential statistical analysis on wound percentage
decrease and healing rates was not conducted between
different wound groups due to small numbers within
each group. As an acceptability and viability study, the
analysis was underpowered to detect significant effects.
2.10 |Ethical consideration and trial
registration
The study was conducted in accordance with the
National Health and Medical Research Council's
(NHMRC) National Statement on Ethical Conduct in
Human Research. The study was approved by the local
institutional review board. Written consent was obtained
from all participants included in the study. The trial was
registered on ANZCTR, registration number
ACTRN12621000344897.
3|RESULTS
3.1 |Participant enrolment and
demographics
A participant eligibility and enrolment flow chart is dis-
played in Figure 2. A total of 51 participants were
enrolled in the eWCC and data were collected for up to
7 months. From these participants, data on 61 wounds
were analysed.
Demographic and clinical participant characteristics
are summarised in Table 1. Participants enrolled in
the study were aged from 30 to 91 years, with a mean
age of 61.9 years (SD 13.4 years). The proportions of
male and female participants were approximately
equal (53% male and 47% female). Over half the partic-
ipants were diagnosed with either a metabolic or a
BARAKAT-JOHNSON ET AL.1775
circulatory system disorder and were being treated for
achroniculcer.
3.2 |Occasions of service
Over a period of 229 days, a total of 828 OOS was pro-
vided to 51 participants through the eWCC. Linear
regression analysis showed each participant received on
average one occasion of service every 4.4 days (r
2
=0.55),
in addition to any phone calls that were conducted but
not captured in the study.
Participants used the notes function of the digital app
to communicate with the wound specialist. All communi-
cations through the notes function were recorded on the
digital platform and could be reviewed by the wound spe-
cialist at any time. In turn, the wound specialist could
respond to the participant through the notes function.
The time of response for each of these communications is
displayed in Figure 3. Approximately 50% of communica-
tion notes were responded to within 2 hours by the
wound specialist, and a median response time of 1.5 hours
was calculated.
3.2.1 | Participant survey - Wound Care
Service
At the beginning of the study period, a total of 55 sur-
veys out of 69 consents (79.7% response rate) were
received. At the end of the study period, participants
still enrolled in the eWCC were asked to complete the
survey again to assess their satisfaction with the eWCC
compared to previous experiences. A total of 44 partici-
pants out of 51 completed the end of study survey, a
response of 86.3%.
There was diversity in treating clinicians providing
wound care services with up to one-third of participants
seeing multiple clinicians to treat their wounds (Table 2).
Once participants were enrolled in the eWCC, a shared
care plan (patient-centred health care plan that is shared
by several members of a care team), was initiated.
Survey scores for wound services at baseline (that is,
before enrolment into the eWCC) were between 4 and
5 for all but one category (Table 3). The highest mean
item score was for wound care services (4.8) and the low-
est was for ease of travel (3.8). Participant survey scores
did not change in each of the categories following their
FIGURE 2 Flow chart for participant enrolment and wound monitoring
1776 BARAKAT-JOHNSON ET AL.
enrolment into the eWCC, again scoring highest for
wound care services (4.9) and lowest for ease of
travel (3.8).
Although baseline data were favourable to start with,
a higher percentage of participants scored a 4 or higher
post eWCC in categories for timely access (98.5% vs 91.7%
at baseline), ease of communication (97% vs 90.3% at
baseline), and ease of travel (69.5% vs 65.5% at baseline)
(Figure 4). In addition, while 89.1% of participants said
they preferred face-to-face consultations at the start of
the study, this reduced to 72.7% after the study, with 25%
of participants scoring impartially (neutral) to this ques-
tion (Figure 4).
TABLE 1 Demographics and clinical characteristics of
participants
Gender N (%)
Male 27 (53%)
Female 24 (47%)
Age Mean (SD)
Age (y) 61.9 (13.4)
Participant diagnosis N (%)
Endocrine, nutritional and metabolic disorders 20 (32.3%)
Circulatory system 15 (24.2%)
Skin, subcutaneous tissue and breast 3 (4.8%)
Neoplastic disorders 2 (3.2%)
Infectious and parasitic diseases 2 (3.2%)
Musculoskeletal sys and connective tissue 2 (3.2%)
Kidney and urinary tract 1 (1.6%)
Digestive system 1 (1.6%)
Hepatobiliary system and pancreas 1 (1.6%)
Mental diseases 1 (1.6%)
Injury, poison, and toxic effect drugs 1 (1.6%)
None 2 (3.2%)
Wound types N (%)
Venous ulcers 19 (31.1%)
Diabetes-related foot ulcers 17 (27.9%)
Postoperative wounds
a
7 (11.5%)
Surgical dehiscence 5 (8.2%)
Pressure injuries 4 (6.6%)
Skin tears and lacerations 2 (3.3%)
Skin grafts 2 (3.3%)
Sinus 1 (1.6%)
Stasis 1 (1.6%)
Other 3 (4.9%)
a
Postoperative wounds that are complex due to size of wound, wound
location, or underlying illness of participant.
2
6
10
14
18
22
26
30
34
38
42
46
>48
0
10
20
30
40
50
60
Time (hr)
Events (%)
FIGURE 3 Frequency distribution of response time by
clinicians on the digital app to participants following receipt of an
image or note
TABLE 2 Treating clinicians/settings where participants (n =
55) were seen for their wound care prior to enrollment in the
Virtual Wound Care Command Centre
Treating clinician
Patient response
number (%)
Wound specialist at the hospital 13 (23.6%)
Local general practitioner 1 (1.8%)
Community nurse 11 (20.0%)
Outpatient clinic at the hospital 12 (21.8%)
Other (patient self-management,
surgeon, hospital department)
6 (10.9%)
Combination of two or more of the
above
12 (21.8%)
TABLE 3 Participant survey on the wound care service, the
categories and scores based on Likert scale (1: strongly disagree to
5: strongly agree)
Survey categories for
wound care
Mean score
Baseline
Post
eWCC
Perception of care services 4.8 4.9
Timely access to wound care
services
4.6 4.8
Ease of communication with
wound specialist
4.6 4.7
Ease of travel and seeing the wound
specialist
3.8 3.8
Self-empowerment and confidence
to manage own wounds
4.6 4.7
Preference for face-to-face
consultation
4.5 4.3
Note: The survey was administered at the time of enrolment (baseline) and
at the end of the study (post Virtual Wound Care Command
Centre [eWCC]).
BARAKAT-JOHNSON ET AL.1777
3.2.2 | Participant interviews
In presenting the data, a pseudonym was assigned to par-
ticipants to maintain their confidentiality. Two themes
were identified from participant interviews that reflect
their experiences in relation to the eWCC:
(a) connectivity is valuable for ongoing access to, and
confidence in, wound care; and (b) remote consultation
complements face-to-face visits.
Connectivity is valuable for ongoing access to, and
confidence in, wound care
A common benefit that participants expressed about hav-
ing their wound managed through the eWCC was their
connectivity to a wound specialist. Participants found it
comforting and reassuring that they could communicate
with the wound specialist at any time and receive a
timely response. This was particularly valued by people
who lived remotely or found it inconvenient to travel.
Tracy, a 49-year-old with a venous ulcer said:
Wound specialists were very knowledgeable
and would respond to questions in a
fast time.
Ben, who was 33 years old and had a dehisced surgi-
cal wound stated:
Someone who's probably alone or doesn't
have that regular follow-up by a nursing pro-
fessional, this would probably help because
at least you've, kind of—you don't need to
wait so long to get feedback, or you don't feel
like you're out of contact which generally
helps because you can at least get a faster
response if you're worried about something.
Participants also found that this connectivity gave
them the confidence to manage their wounds. They felt
that having an open line of communication with their
wound specialist alleviated concerns and provided reas-
surance about their wound dressings and healing pro-
gress. Anita, who was 52 years old and had a liver
transplant, developed a clot that had resulted in a very
deep wound, explained:
So, for me to actually go to the hospital to be
treated, but also have the confidence and
reassurance to leave there and know that if
something did happen, I could actually mon-
itor it myself and communicate with …the
wound care professional, was just so, so
good, as I said, so reassuring and just left me
with that confidence.
Nellie, a 61-year-old who had bilateral forefoot ampu-
tation wounds and lived in a rural community disclosed:
We were flying blind because nobody's dealt
with forefoot amputations out here. And
what did we do and what to expect sort of
thing …is this good or is this bad or is this
something that we need to do …to have that
contact and ability to talk to [wound special-
ist] and converse with [wound specialist] for
suggestions about what to do or, you know,
et cetera was great. It really was …[wound
specialist] did ring me a number of times
as well.
Remote consultation complements face-to-face visits
Participants commented that virtual care was very conve-
nient for those who were not mobile, or needed to travel
0255075100
Face-to-face consultation
Self-empowerment
Ease of travel
Ease of Communication
Timely access
Wound management
% patients that scored in each category
Baseline
Strongly
disagree
Disagree Neutral Agree Strongly
agree
77.8%
76.4%
72.0%
29.7%
69.1%20.0%
35.8%
18.3%
15.2%
20.4%
17.4% 74.3%
14.5%13.9%
12 345
0255075100
Face-to-face consultation
Self-empowerment
Ease of travel
Ease of Communication
Timely access
Wound management
% patients that scored in each category
Post eWCC
Strongly
disagree
Disagree Neutral Agree Strongly
agree
86.4%
80.8%
78.8%
18.2%
59.1%25.0%
76.1%
18.2%
17.7%
13.6%
27.3% 42.2%11. 4 %
13.6%
12 345
(
A
)
(B
)
FIGURE 4 Participant survey results at (a) the time of enrolment (baseline) and (b) the end of the study (post eWCC). Data presents
percentage of participants that scored in each Likert scale category. eWCC, Virtual Wound Care Command Centre
1778 BARAKAT-JOHNSON ET AL.
long distances, in times when lockdowns prevented par-
ticipants from travelling. Jean, the age of 59 years, was a
patient of the high-risk foot clinic stated:
I just think it's a very good idea for people
that aren't mobile and don't need to be seen
face-to-face regularly.
Morris who was 64 years old with peripheral vascular
disease and had vascular ulcers explained:
And with the thing of COVID sometimes we
can't get there because of the lockdown. So, by
having the use of that app, usually we dressed
it at night. My wife will take the picture, she
does the dressing and that. She can send it to
[wound specialist] and we'll probably have an
answer within a quarter of an hour.
Some participants enrolled in the eWCC were also
making scheduled visits to the wound specialist as part of
their programme. In this setting, participants noted that
the remote service complemented the scheduled visits
and, at times, reduced the number of face-to-face visits.
John, aged 44 years, who had a diabetic foot ulcer
stated:
…it's a tool that the people who are treating
your wound should introduce and use that to
reduce face-to-face consultations.
Tom, aged 68 years old, with peripheral vascular dis-
ease and a postoperative foot wound explained:
They'd tell me if they—once they saw the
photos, they didn't want to see me, they
would call me and say—in the end, it went
from once a week to every two weeks.
3.3 |Usability and acceptability of the
digital app
3.3.1 | Participant survey - Digital app use
Participant survey scores and percentage response to ques-
tions on the digital app are shown in Table 4and
Figure 5, respectively. Participants rated the use of the dig-
ital app and its effectiveness in wound management very
favourably, with average scores of 4.0 and above recorded
in the respective categories (Table 4). A total of 84.1% of
participants found the digital app easy to use, 86.3% of
participants agreed it was a tool to support face-to-face
consultations, and 86.4% of participants recommended the
digital app for wound care management (Figure 5).
3.3.2 | Participant interviews
The narrative themes regarding the digital app from par-
ticipant interviews included: (a) a digital record in your
pocket; (b) tracking the progress of wound-healing is sim-
ple; and (c) digital apps—learning to overcome technical
challenges.
A digital record in your pocket
Participants found that having a record of the wound pro-
gress and a record of communication notes from the
wound specialist on their mobile device was very useful
when visiting their GP or seeing other specialists. This
enabled them to communicate with their additional
treating clinicians on their wound progress and, at times,
prevent the need to undress and re-dress the wound. Nellie,
who had bilateral forefoot amputation wounds stated:
TABLE 4 Participant survey on the digital app; score based on
Likert scale (1: strongly disagree to 5: strongly agree)
Survey categories for the digital app
Mean
score
Ease of use 4.2
Timely access to wound care services 4.0
Ease of communication with wound specialists 4.0
Reducing travel to see the wound specialists 3.6
Self-empowerment and confidence to manage
own wounds
4.0
Supporting face-to-face consultation 4.4
Recommended for wound care management 4.5
0 25 50 75 100
Recommendation for wound care
Face-to-face consultation
Reducing travel
Ease of communication
Self-empowerment
Timely access
Ease of use
% patients that scored in each cate
g
ory
Strongly
disagree
Disagree Neutral Agree Strongly
agree
50.8%
40.2%
43.2%
27.3%
68.2%
18.2%
34.1%
34.1%
34.8%
33.3%
40.9%34.1%
29.5% 56.8%
12 345
FIGURE 5 Participant survey results on the digital app for
wound care management. Data shows percentage of participants
that scored in each Likert scale category
BARAKAT-JOHNSON ET AL.1779
Showing the doctors, including, my specialist,
the surgeon from Sydney one of the photos of
what it was—where it was actually—so when
I had a teleconference with him, he was able
to see where it was up to.
John, age 44 who had a diabetic foot ulcer said:
And rather than undress the wound every
time and then get the nurse to redress it at
the GP again, I would often just pull out the
app and, ‘here's the photo that I took yester-
day, here's the photo I took the day before’
and they'd just look at the photo and go,
'yeah, that looks good.'
Tracking the progress of wound-healing is simple
The biggest benefit noted by participants was the ability
to see wound progression in the images taken. The digital
app arranged the images in chronological order making
it easy to visualise progression and the images were not
saved to the phone's photo gallery, which was important
for privacy. Morris who is 64 with peripheral vascular
disease reported:
And with taking photos, they're, sort of, in our
photo book that we can always go back there
and use them to judge how things are going and
that…I'm very, very impressed with the app.
And being able to physically see—because
I'm a visual person—physically see how it
drilled along for a while—the healing—and
suddenly it got a go on. And that gives you
confidence particularly in your older years.
The digital app uses artificial intelligence to perform an
analysis of the wound every time an image is taken. While
this feature is particularly liked by clinicians,
20
the inter-
views showed that participants were not equally favourable
to the analysis feature. Participants preferred viewing their
progress through chronological sequence of images, rather
than using the analysis, which generates a percentage of
wound change. In Nellie's experience, the digital app:
Did width, total area and length. But these
seemed to be inaccurate.
As John expressed:
…so the dot may be on an angle, …. where
it's, oh your wound has grown and the nurse
was like, no it hasn't.
And for Ben:
…a bit hard to decipher the information from
the application because it tends to give you
detail around the change in wound size. But
it's very inconsistent.
Digital apps—learning to overcome technical challenges
Participants frequently commented how they enjoyed
the digital app because of its ease of use. In some
instances, participants gave their device to their com-
munity nurse or family member to take the image for
them. While some participants noted they experienced
some difficulties in the beginning, these were easily
corrected, and they quickly became accustomed to
using the digital app. For Tracy, a 49-year-old with a
venous ulcer:
It was quite user-friendly, like it wasn't com-
plex, so that was good.
Nellie, who has bilateral forefoot amputation wounds
stated:
Taking the photos was easy. And the quality
of the photos was really good.
And for John:
I found the app very useful. Easy to use.
Taking images using the digital app requires the par-
ticipant to place a green dot near their wound and take
an image planar to the sticker and wound. Some partici-
pants reported forgetting to use the green dot; others
were not sure where to place it, especially for wounds on
body extremities. For Ben it was:
…bit hard to use it for a wound that isn't of
very flat and easy to image.
And for John it was:
…hard when [the] wound is on the toes to
place the dot in a position on the same plane
as the wound. This then skews the analysis.
3.4 |Wound analysis
Analysis of each wound was conducted from time of
enrolment until the wound healed or until the final
wound evaluation date for an unhealed wound. The
1780 BARAKAT-JOHNSON ET AL.
number of wounds that were completely healed within
the 7-month study period was 26/61 (42.6%), with a
median time to healing of 66 (95% CI: 56-88) days. Nine-
teen out of 26 wounds (73.1%) healed in less than
12 weeks, and all 26 wounds that healed did so within
24 weeks. The different types of wounds (as listed in
Table 1) were grouped into five categories and healing
outcomes for each wound category are displayed in
Table 5.
Out of the remaining wounds that were still being
managed by eWCC, 29 (82.9%) had improved since the
time of enrolment, with a mean reduction in wound SA
of 51.9% (SD 21.2%). There were 6 (17.1%) wounds, which
displayed a mean increase in wound SA of 25.9%
(SD 25.8%). Two of these wounds were from a patient
with multiple venous ulcers, one was from a very elderly
patient with deteriorating health and the other three had
been monitored for less than 3 weeks.
3.5 |Potential savings due to reduced
travel
This study showed that enrolment in the eWCC reduced
the number of visits that a participant made to the
wound specialist, but this was highly dependent on the
participant's situation. For example, eight participants
enrolled in the eWCC received primary care through
community nursing or hospital in the home services
(a clinical area to treat participants after discharge to
reduce hospital length of stay),
27
and therefore, they did
not travel to see the wound specialist. Whereas other par-
ticipants did travel to see the wound specialist and these
visits were modulated through the eWCC. Twenty-three
participants lived in metropolitan Sydney and visited
wound specialists within metropolitan Sydney, 12 partici-
pants lived within regional/rural NSW and visited wound
specialists within regional/rural NSW and 8 participants
lived in regional/rural NSW but visited wound specialists
in metropolitan Sydney. The travel distance, time, costs,
and car pollution emissions were calculated per round
trip for these participants and displayed in Figure 6.
The data demonstrated that savings for a single round
trip can be experienced by all participants. Participants
within metropolitan Sydney potentially saved, on aver-
age, a distance of 20.5 km (SD 16.2 km), travel time of
54 minutes (SD 25 minutes), and travel costs of $6.37
(SD $10.26) for a single visit. Participants that lived in
regional NSW and travelled to their closest wound spe-
cialist potentially experienced travel savings of a mean of
260 km (SD 191 km), 3.1 hours (SD 2.1 hours), and
$38.02 (SD $28.46) for a single visit. Greatest savings were
experienced by those participants accessing wound spe-
cialist services remotely with a single visit potentially
costing a mean of 638 km (SD 265 km) travel distance,
8.6 hours (SD 2.5 hours) travel time, and $99.65
(SD $42.07) fuel costs. Notably, these savings grow sub-
stantially over the course of treatment where participants
can avoid numerous trips, as they remain connected to
the specialised service.
In addition, the reduced travel commuted by partici-
pants equates to a reduction in CO
2
emissions into the
atmosphere of up to an estimated 250 kg for a single
round trip for remote participants. To put this in perspec-
tive, the average annual CO
2
emissions were estimated
and compared to the number of mature trees that would
need to be planted to offset this emission. From this data,
around 30 to 850 trees per patient would be required to
TABLE 5 Wound-healing outcomes
Wound type
Proportion (%)
healed in <12 wk
Proportion (%)
healed in <24 wk
Mean (SD)
wound
area (cm
2
)
Mean (SD) Median
(IQR) healing time (d)
Mean (SD)
healing
rate (cm/d)
Vascular
ulcers
3/19 (15.8%) 3/19 (15.8%) 7.71 (7.45) 63.7 (20.5) 62 (44–85) 0.014 (0.008)
Diabetes-
related foot
ulcers
8/17 (47.1%) 11/17 (64.7%) 3.81 (5.30) 69.5 (32.3) 77 (24–94) 0.011 (0.006)
Complex
surgical
wounds
a
6/14 (42.9%) 10/14 (71.4%) 10.6 (13.0) 76.7 (44.1) 64.5 (33–129) 0.019 (0.013)
Pressure
injuries
(stage 4)
0/4 (0%) 0/4 (0%) —— —
Other wounds 2/7 (28.6%) 2/7 (28.6%) 21.1 (23.3) 58.5 (5.0) 89.5 (62–117) 0.04 (0.034)
a
Postoperative, surgical dehiscence, skin graft.
BARAKAT-JOHNSON ET AL.1781
be planted to offset carbon emissions by participants
accessing wound services in metropolitan and regional/
rural districts of NSW, respectively.
4|DISCUSSION
Wound care in Australia is complex, compounded by a
tyranny of distance within a vast geographical area, and
often involves a multitude of un-coordinated health care
providers with varying degrees of knowledge and skill in
treating chronic wounds.
3
The eWCC is a new MoC that
aims to improve patient wound outcomes by providing a
continuous, accessible service with ongoing remote
review of chronic wounds and respective administration
of wound care through a virtual setting. This study found
that the eWCC enabled patients and other health profes-
sionals to work collaboratively while directly accessing
centralised specialised wound consultation services
remotely; thereby ensuring the patient receives best prac-
tice wound care. In addition, patients could directly
access information about their wound progress via the
digital app, empowering them to participate in the man-
agement of their wounds and use this tool, which was
used to communicate with their local treating clinicians
as needed. The model is designed to provide remote
access and timely interventions for patients in the
community, administer evidenced-based treatment and
preventative care, and enable continuum of care across
the health services.
This study assessed the eWCC from nine centres
across NSW health districts, encompassing community
services, outpatient clinics, and hospital wound special-
ists. A pre-enrolment baseline survey showed that
patients were satisfied with their wound care service pro-
vided by their wound specialist (nurse specialists, podia-
trists, doctors, surgeons). A high proportion of patients
perceived that wound care services through the eWCC
provided improved timely access and ease of communica-
tion to their wound specialist, and increased confidence
to self-manage the wound. Therefore, the eWCC was able
to deliver effective remote wound services to patients
without compromising on quality and patient satisfac-
tion. Accordingly, the data demonstrated that patient
safety was not diminished through remote care via
the eWCC.
The use of digital technology for remote wound care
is an important feature of wound care management,
especially for patients that are immobile due to illness,
travel constraints, or mandated lockdowns from pan-
demics. The platform provided by the digital app enabled
participants to stay connected to wound specialist ser-
vices and this was perceived as a valuable feature of the
digital app, evidenced by the timely communication
0 100 200 300 400 500 600 700 800 900 1000
Distance (km)
metropolitan
patient
remote
patient
regional
patient
(A)
0 20 40 60 80 100 120 140 160
Cost ($)
metropolitan
patient
remote
patient
regional
patient
(C)
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Time (hr)
metropolitan
patient
remote
patient
regional
patient
(B)
0 50 100 150 200 250 300
CO
2
emissions (kg)
metropolitan
patient
remote
patient
regional
patient
(D)
FIGURE 6 A single round trip savings for a patient in the eWCC. The figure displays minimum and maximum values with centre line
at the median value for (a) distance, (b) time, (c) costs, and (d) CO
2
emissions for a single round trip to the wound specialist for participants
who lived in, and accessed services in, metropolitan Sydney (metropolitian patient, dark grey), participants who lived in regional/rural NSW
but accessed services in metropolitan Sydney (remote patient, medium grey), and participants who lived in and accessed services in regional/
rural NSW (regional patient, light grey). eWCC, Virtual Wound Care Command Centre
1782 BARAKAT-JOHNSON ET AL.
responses between the participant and wound specialist.
In addition, participants reported the digital app was easy
to use and they benefited from being able to track their
wound progress. Previous studies
13,15,28
have reported on
remote consultations through telehealth and how they
were non-inferior to face-to-face consultations and pro-
vided timely assistance and diagnosis to improve man-
agement of chronic wounds.
29,30
The eWCC goes further
to provide a solution where patients can 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. Recognisably, the
use of video telehealth consultations can be used to com-
plement the delivery of evidenced-based wound care
practice through the eWCC.
Although the study was not designed to compare
healing rates of wounds with a comparator group, it did
reveal that the digital app provided a very quick and effi-
cient way of extracting detailed wound parameters for each
participant. In fact, the introduction of the digital app has
enabled the accurate and comprehensive analysis of
wounds,
31
which was not possible through the eMR system
used in the study setting.
20
Wound-healing data collected
in this study was comparable to previously published data.
Patients with ulcers assessed via telemedicine were
reported to have a median healing time of 59 days (95% CI:
40-78) in one study
29
and an average healing time of 65.8
(SD 29.8) days in another.
32
Astudyassessingchronic
wounds in rural Australia over 3 years reported a mean
healing time of 61.4 (SD 77.7) days.
33
Patients with a mixed
aetiology of ulcers visiting an outpatient wound clinic
reported 35% healing rate within 12 weeks.
34
Other studies
have reported vascular ulcers to heal at a range of 23.5% to
45.1% within 24 weeks, a median healing time of 63.9 days
7
and a median healing rate of 0.15 cm/wk (0.13-0.19 CI),
35
which was comparable to our data of 15.8% healed within
24 weeks, a median healing time of 62 days (IQR: 44-85)
and a median healing rate of 0.13 cm/wk (0.034-0.23 CI).
Diabetes-related foot ulcers have been reported to have a
median healing time ranging from 6.0 to 15.7 weeks
(42-110 days).
7,35
Another study reported a median healing
rate of all ulcers of 0.55 cm
2
/mo (IQR: 5.27-0.18).
34
Com-
bining vascular and diabetes-related foot ulcer data from
our study showed a median healing rate of 0.75 cm
2
/mo
(IQR: 3.23-0.42). The ability to extract comprehensive
wound information using the digital app will further sup-
port studies investigating new methods and products to
improve healing of chronic wounds.
Translating a digital app system into an effective MoC
for the remote treatment of chronic wounds is critical to
service patients in rural/remote settings. In addition to
providing direct access to specialist wound services,
patients can benefit from time and cost savings associated
with travel. Similar to our previous study,
20
travel savings
were achieved by participants enrolled in the eWCC and
in turn, reduced carbon emissions, providing environ-
mental benefits. In addition, the outbreak of the COVID-
19 pandemic mandated physical separation between cli-
nicians and patients and restricted travel. In these cir-
cumstances, the effective delivery of remote wound care
is imperative to prevent wound deterioration. This study
demonstrated that the eWCC provides an efficient and
user-friendly platform that can be rapidly deployed to
provide remote services to patients with chronic wounds.
The effective delivery of wound care services through
the eWCC is partly dependent on patient accessibility
and use of the digital app. First, in this study, it was
observed that a high percentage of eligible patients were
not enrolled due to either having a difficult wound loca-
tion or having issues with their mobile device. Patients
with a wound in a difficult location could not use the dig-
ital app to take images of their own wound. In this situa-
tion, patients may have a family member or visiting
community nurse takes images, or their treating clinician
can use the app to access expert advice on behalf of the
patient. While the design of this study did not include
studying the experience of treating clinicians in the com-
munity, future expansion of the eWCC to such clinicians
will be important to improve services to patients in the
community. Second, approximately one-third of patients
were excluded from the study due to device issues. These
patients either did not have a smart phone device or did
not have an account to download digital apps. Making
the digital app easily available to patients will be impor-
tant for centres to deliver effective wound care and this
can be achieved by offering patients a mobile device with
the downloaded digital app so they could benefit from
remote wound monitoring.
The study design employed to assess viability and
acceptability of the eWCC meant that a comparator
group was not used to compare the new eWCC MoC to
standard of care. Instead, this study implemented a sur-
vey to be conducted by participants at the time of enrol-
ment to establish baseline data of their perception
towards current wound services. The same survey was
used at the end of enrolment to establish their perception
of the eWCC. The surveys were anonymous to minimise
biasing of data. In addition, participant interviews were
conducted to enrich the data from the surveys. The com-
bined data clearly demonstrated the favourable percep-
tion that participants formed with receiving wound
services through the eWCC using the digital app. Future
studies can be designed with a larger cohort and compar-
ator groups to determine if wound-healing outcomes
improve and if there are any cost efficiencies to be gained
BARAKAT-JOHNSON ET AL.1783
using the eWCC MoC compared to standard care. Lastly,
exploring the perspective of clinicians on the eWCC
would give insights into receptiveness, uptake, barriers,
and facilitators for future scale up for different specialists
and settings.
In conclusion, individuals with chronic wounds
receiving remote wound care services through the eWCC
using the digital app experienced improved timely access
to wound care services, ease of communication with their
wound specialist, and self-empowerment to manage their
wounds. Remote monitoring of wounds did not decrease
the quality of care or increase risk to the patient. Patients
valued the direct connectivity afforded by the digital app
to their wound specialist for continued wound care and
confidence in wound management. In addition, most
patients found the digital app easy to use, suggesting the
use of new digital technology was acceptable among an
older generation that is prone to chronic wounds. Collec-
tively, the study provides a valuable analysis of the
eWCC, demonstrating its viability and acceptability for
providing virtual wound care services while maintaining
quality and patient experience. This supports the contin-
ued expansion of this work across the health network.
ACKNOWLEDGEMENTS
We would like to thank the ongoing support of our Execu-
tive Sponsor, Ivanka Komusanac, Executive Director of
Nursing and Midwifery at the Sydney Local Health District.
We would like to extend our sincere gratitude to the
patients and wound specialists who participated in this
study. We thank, in particular, our System Architect, Gina
Tsaprounis. We also thank Cathy Yates, Operational Man-
ager of the University of Sydney's Charles Perkins Centre
for assisting in the establishment of an eWCC at Royal
Prince Alfred Hospital. We thank Tissue Analytics™for
subsidising the cost of the digital app and providing ongo-
ing product training, support, and troubleshooting. Tissue
Analytics™did not have any input into the design, con-
duct, analysis, or write-up of this study. This study was
funded by the Medical Research Future Fund (MRFF),
Rapid Applied Research Translation (RART) initiative
Round 3 (2021), and Sydney Health Partners. Sydney Health
Partners is a research organisation that was accredited by
the NHMRC in 2015 as a world leader in translating
research into better health outcomes for our communities.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are avail-
able from [third party]. Restrictions apply to the avail-
ability of these data, which were used under license for
this study. Data are available [from the authors / at URL]
with the permission of [third party].
ORCID
Michelle Barakat-Johnson https://orcid.org/0000-0001-
7764-4515
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How to cite this article: Barakat-Johnson M,
Kita B, Jones A, et al. The viability and
acceptability of a Virtual Wound Care Command
Centre in Australia. Int Wound J. 2022;19(7):
1769-1785. doi:10.1111/iwj.13782
BARAKAT-JOHNSON ET AL.1785
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