Continuity of Care: Examining What Happens to Patients with Chronic Wounds After Hospital Discharge

Objective: Individuals with chronic wounds receive care while hospitalized for complications arising from the wound. Many individuals fail to seek outpatient follow-up care. These persons are often re-hospitalized for complications arising from untreated wounds and risk amputation or death.

Methods: Patients were included if they were consulted on by wound care staff at a primary medical facility during a 3 month period irrespective of their reason for hospitalization. Demographics, comorbidities, length of stay, disposition and wound etiology was recorded. The Charleston Comorbidity Index (CCI) was used to calculate an objective value for the health status of the patient. We investigated if an appointment with an outpatient wound care clinic was made, if they attended, and if the patient was either re-admitted or had expired within 90 days of the original date of discharge.  

Results: 200 patients were seen by the hospital’s wound care team. The average age at time of admission was 71±17.5. Over 75% were Medicare recipients. Mean hospital stay was 11 days. 62.1% were discharged home, 35.9% were sent to skilled nursing facilities. The mean CCI score of these patients was 4.19. 41.5% patients were seen for pressure ulcers, 29% vascular ulcers, and 7% for diabetic foot ulcers (DFU). 
Of the patients who did not have a follow appointment scheduled (N=127), 35.4% patients were either re-admitted or expired within 90 days of discharge. 10.5% of patients who cancelled or did not show up for their follow up appointment (N=30) were also hospitalized or had expired. Only 7.5% of the 43 patients who attended a follow up appointment fell into the same category of readmission or mortality. 

Conclusion: Follow up care after discharge is quintessential to a patient’s health. Patients who do not seek appropriate care for chronic wounds in a timely manner risk re-admission, amputation and/or death.