Future Education Needed to Fill the Gaps with Instillation Therapy

In this video, Paul J Kim, DPM, MS, FACFAS, discusses the areas of future research which are needed to fill the gaps in instillation education, especially when considering clinical use.

Transcript

My name is Paul J Kim. I'm a professor in the Departments of Plastic Surgery and Orthopedic Surgery at the University of Texas Southwestern in Dallas, Texas. Also, the medical director of the wound program there.

I think that the answer is multivariate. I think a couple of things, there's been some new innovations in negative pressure wound therapy with insulation. Specifically on estimating solution volume, which has really been a problem for novice and intermittent users. People that are really pretty veteran at the use of negative pressure wound therapy with insulation is able to kind of guesstimate how much volume you should be used as far as the insulate is concerned. When you're a novice or intermittent user, it's a lot of guesswork. And unfortunately, they've had some adverse problems with that with leaks and macerations, and therefore this new innovation is actually just a computer software upgrade where it automatically calculates the volume for you.

Now, my early experience with using this new innovation is that it under-instills the amount of volume that I'm typically used to seeing. But however, for the novice and again, the intermittent user, I think it's a great innovation. So it's interesting from my perspective, I came from a very heavy research effort at Georgetown University Hospital, where I spent about 10 years. When I came over to the University of Texas Southwestern in the last three years, my role is different. I'm a halftime administrative. So my hands are in the operational pieces of wound programs and wound centers, and both in and outpatient wound programs. And what I've learned is there's a lot of behind-the-scenes activity that happens, and a lot of it's driven by economics. And there're existing contracts, with different vendors. There're incentives built-in as far as the use of supplies and all those things. I think to drive from the clinician's perspective, ultimately what products they can and can't use.

In the end, the most important aspect that should be driving the adoption of the new biologic device or drug should be the clinical outcome. And that clinical outcome can be measured in many different ways. And from the administrative side, I think the efficiency of the delivery of care is very important and really that can be reflected in a lot of things. And they all result in cost savings in the end. Things like if you can decrease the length of stay of a patient, that's a high-cost saver for the health system and for insurers and taxpayers and everybody else ultimately. But you can't sacrifice the quality of care at the same time. So you need to be able to balance those two. How do we efficiently deliver care, and provide continuity care after being discharged from a hospital setting, which is the most costly piece of healthcare now during hospitalization?

Clinical, the clinical outcomes are obviously the most important thing. There are those external drivers that actually, they're a bigger driving force than people can appreciate. And especially if it's just the everyday clinician. They don't realize that some of these decisions they think they can make are actually made out outside of their control. But it is still our, I think, collective responsibility to look at things critically. Look at the evidence and whether it's for or against a device, biologic or drug, I think it's on us to make those decisions.