9 Remote wound reviews: empowering patients and parents throughout COVID and beyond

Background Post-operative wound reviews constitute an essential part of care for children undergoing surgery, allowing prompt identification of post-operative complications. Until now it has been routine practice in the orthopaedic department to delegate wound reviews to community services. However, departmental follow-up may have significant benefits including improved continuity of care. Additionally COVID-19 has meant that avoiding face-to-face consultations has greater appeal, particularly for patients with significant co-morbidities. We developed a remote service for safe and patient-centred orthopaedic wound checks. Methods Stake-holder perspectives were captured by surveying parents as well as orthopaedic surgeons within the department. Suitable patients were identified and provided with a choice between remote wound checks (RWC’s) versus community services as standard. Patients opting for RWC’s were asked to upload photographs of their wounds to MyGOSH two weeks post discharge. Once images had been reviewed a telephone consultation took place during which the Bluebelle wound healing questionnaire was carried out. Parental satisfaction scores were gathered following telephone consultation. Results 100% of staff respondents supported a RWC service. A total of 7 patients were identified as suitable for this pilot, all opted for RWC over routine community follow-up. All 7 patients received a remote wound check within 2 weeks of discharge (mean 11.7 days). One parent reported visiting their GP prior to remote review citing low confidence with dressing removal. All patients had reassuring photos and Bluebelle scores requiring no further follow-up prior to routine clinic. The median Bluebelle score for the cohort was 3 (high score indicating wound complications, maximum 41). Mean satisfaction score amongst parents was 4.3 (out of 5). Conclusion RWC’s are desirable amongst our patient cohort. Parents engaged well with the remote service and satisfaction was high. Following this pilot we propose expansion of this service to empower families in the COVID-era and beyond.