FAQs about Project ECHO Ontario Skin and Wound Care

Answers to popular questions we get asked. You might also wonder about the cost – that’s easy! There’s absolutely no cost to health practitioners in Ontario who qualify and register.

1. How does Project ECHO Ontario Skin and Wound work?

The ECHO model™ links specialists and the resource team (the Hub) with primary care community-based partners (Spokes) – i.e. a hub and spoke model. The online sessions are 2-hours weekly and include a short educational lecture, followed by case-based learning from the participants’ own patients. The combination – live online sessions and in-person skills training – is a way to build health care capacity.

The resource team puts together the content of the ECHO educational lectures. Participants present de-identified cases of their own patients during the live online sessions. Participants also contribute to case discussions and evaluation surveys. They also receive continuing education/ continuous professional development credits (CE/CPD).

Through the ECHO model, community providers and specialists learn from each other, acquire knowledge, skills, increase competency and build a strong community of practice. Participants become part of a supportive community of practice and an inter-professional team.

2. What will participants learn from Project ECHO Ontario Skin and Wound?

Wound and skin care issues, including:

  • Diabetic foot ulcers
  • Pressure injuries (ulcers)
  • Venous leg ulcers
  • Common dermatological issues related to wounds e.g. hidradenitis suppurativa

3. What is the curriculum based on?

4. What is required of participants?

A. Time: Weekly 2-hour sessions: 15 minute educational lecture, followed by around 90 minutes of patient case discussions. There will also be opportunities to attend in-person ‘boot camp’ skills trainings a few times per year, to be held at various locations in Ontario.

B. Internet Access and a Webcam Enabled Device: Participants must attend the online sessions that will be offered via Zoom technology, a free online platform accessible from most desktops, laptops and smartphones. A webcam is highly encouraged as the learning experience will be highly visual and interactive. Participants will also be encouraged to download supplementary reading and material that will be made available online.

C. Commitment: As space is limited and demand is high, we ask that interested persons who sign-up commit to attending the majority of the online sessions and sign a written statement of collaboration. We also ask that participants act respectfully towards each other and members of the resource team.  Further, participants should ensure that there is no sharing of identifiable information regarding the patients of the cases presented.

5. What costs are involved?

ECHO Ontario Skin and Wound is provided at NO COST to Ontario based health care providers.

6. What are the benefits for health care providers?

  • Enhanced care for patients with skin and wound care issues
  • Certificate of Attendance, if a regular participant
  • Continuing Medical Education (CME) Credits awarded by Queen’s University
  • Being part of an interprofessional community of practice

7. How to sign up?

Sign up by filling out this 5-minute Application form.

8. When does the Project start?

Sessions run every Wednesday, starting June 2019. We are offering a total of 64 sessions of tele-ECHO for acute and chronic wounds. These will be held in three annual cycles.

9. How will participants be selected?

Health care providers with an interprofessional team and working in health care organizations within Ontario are welcome to apply; however, space in Project ECHO Ontario Wound and Skin is limited.

Preference is given to health care providers who can participate in the online sessions as part of an interprofessional team, who are in underserviced areas, or who often treat First Nations, Metis, and Inuit people living in Ontario.

10. How can I learn more?

The Project ECHO Ontario Skin and Wound Care ABOUT page has more information about the project, the international movement, the Ontario Superhub, and the other 15 Project ECHO Ontario Hubs.

We also post updates on Twitter: @ECHOWound

Three standout features: Is this the right opportunity for you?

Are you a health care provider in Ontario who wants to ensure patients with wounds are treated safely and effectively?

In 2016, Dr Gary Sibbald and three other project members travelled to the University of New Mexico to attend a three-day Project ECHO Immersion session. The was the start of what’s become an ongoing relationship with Project ECHO Replication Team, and the orientation and training needed to successfully start Project ECHO® Ontario Skin and Wound Care.

You might be considering if the program is for you and your community of practice, so here are the top three features of the program to consider:

1. Targeted Needs Assessments

Assessments of needs and environmental resource scans are carried out to determine cognitive, affective, and psychomotor competencies of providers, individual and system needs related to skin and wound care and availability of evidence-based resources.

2. Tele-ECHO Curriculum

Project ECHO WoundPedia/BPSO Ontario Skin and Wound Care sections are based on the established and highly successful International Interprofessional Wound Care Course (IWCC), RNAO Wound Care Institute and Wounds Canada courses, as well as the results from the assessments.

The Tele-ECHO curriculum provides a comprehensive educational experience. You’ll learn how to:

  1. Assess and critically review Best Practice Guidelines and best practice guideline summary documents related to wound care in key subject areas.
  2. Integrate wound care principles by a self-directed learning program formulated with a learning contract.
  3. Demonstrate the application of best practices by developing an elective related to the learner’s everyday activities.

The current IIWCC modules are built on the scientific evidence outlined by best practice guidelines interpreted by an international faculty of wound care, education and research professionals both from academia and community wound care practice. These modules have been developed into Project ECHO Skin and Wound Care curriculum.

3. Continuing Medical Education Accreditation

Clinicians (Spokes) who are part of the Project complete a pre-test prior to the beginning of the sessions and a post-test after the sessions have completed assessing the changes in knowledge, attitudes, behaviours and current knowledge translation. Polls and short weekly evaluation surveys are also be completed by project attendees after each weekly session.

Participants who attend the weekly session and complete the evaluation receive a certificate of CME credit for each attended session.

7 Project ECHO Skin and Wound Care tools you should know about

In addition to virtual clinics, we are steadily growing the number of tools and resources that are freely available

Tele-ECHO sessions are the cornerstone of the Project ECHO Skin and Wound Care program. These virtual clinic sessions are held weekly using web conferencing so clinicians across Ontario can participate via the internet.

We host the Tele-ECHO sessions at the Hub studio, which is physically located at the Toronto Regional (Dermatology) & Wound Healing Specialty Clinic in Mississauga, Ontario. The clinic has a conference room, as well as Ontario Telemedicine Network capabilities. RNAO BPSO staff join each session either at the Toronto RNAO office or remotely if working off-site. We use Zoom to connect HUB personnel and consultants across Ontario.

The sessions are expert-led virtual clinics, with a capacity for up to 25 participants. In each session, a clinician presents a case relating to the subject matter. For example, if the section is on diabetic foot care, members will introduce de-identified case studies. We aim to review three cases per session, consisting of two new cases and one follow-up case.

In addition to the virtual clinics, several Project ECHO tools can be used to support your practice. These are just a part of the growing library of Project ECHO resources.

1. Case Intake Form

The Case Intake Form standardizes case management and populates a wound care case ‘bank’. It is based on previous ECHO case intake forms and modified for established wound care variables, for example, HbA1c level, ABPI index, suggested wound diagnosis. We review cases in advance to make sure no identifiable information will be included on the forms or in the case bank.

2. Tele-ECHO Case Database

We are building a case library, which is a computerized data system that matches documents cases with new cases. The database also provides data on patient outcomes for the Best Practice Service Organization (BPSO) RNAO Centre, the BPSOs and for the Hub and members.

3. Best Practice Enablers

Best Practice Enablers are summary tools used to condense practical knowledge efficiently. These are uploaded to the members’ document centre as the RNAO BPSO Centre develops them.

4. Session Summaries

After each session, a summary of the discussion is prepared and sent to all participants via email. We also post them in the members’ document centre, and a forum topic is set up for online discussion.

5. Case Reviews

After each joint case review, we post a suggested care plan summary to the members’ document centre. They act as an aide-mémoire to help optimize care for future patients.

6. Clinician Self-Efficacy Questionnaire

The questionnaire assesses confidence in abilities, skills and knowledge, and is completed via a secure web-based survey.

7. Knowledge Tests

These evaluate the extent of iterative learning and the effect of knowledge networks. They are administered both before and after exposure to the ECHO model. We track the number of CME credits or other types of educational credits (as determined) and post them to your member profile.

These are just some of the resources that we are developing. In addition to the wound care cases bank for members, there are always new resources publicly available for download in the Hub Library. And when you subscribe for updates or apply to be a Project ECHO Ontario Skin and Wound Care Spoke member, you have the option of getting weekly updates on new resources by email.

Three questions about alignment with Ontario’s health priorities

How the project lines up the government’s plan for changing and improving Ontario’s health system

Innovations such as Project ECHO work in alignment with system priorities. The Project ECHO Skin and Wound Care team took a look at how we align with three major government health care initiatives.

Question 1

Patients First: Action Plan for Health Care has been in place since 2012 and centres on the commitment to put people and patients at the centre of the system by focusing on putting patients’ needs first. How are you doing that?

Answer: Improved access to co-ordinated, interprofessional chronic wound care will heal Ontarians faster, lowering the number of related emergency room visits, hospitalizations and amputations. The project will increase capacity among regional primary care providers and newly established interprofessional teams and sub-HUBs to improve access to the most appropriate care in the most appropriate place while decreasing costs.

Additionally, the ECHO model will help build regional expertise. The Hub, along with the expertise of the International Interprofessional Wound Care Course (IIWCC) faculty, will facilitate the development of distributed expertise that may potentially lead to SPOKES that can become regional Hubs.

Question 2

Health Quality Ontario is the go-to for advice and data and has the mandate to define health quality and health system improvement. How are you working with them?

Answer: Health Quality Ontario (HQO) recently developed Quality Standards for diabetic foot ulcers, pressure injuries and venous leg ulcers, as part of an Ontario-wide expert panel I co-chaired. This project will help the province-wide implementation of these Quality Standards.

Question 3

What about the Ministry-LHIN Wound Care Quality Standards Implementation Project?

Answer: The activities of the Project will inform this group and vice-versa. In partnership with the LHINs, the Ministry of Health and Long-Term Care is working to engage with stakeholders on wound care, in system capacity review and planning, and to identity and fund training and education resources and fund new wound care devices. There’s also work being done to develop a performance monitoring and data/analytic framework.

Best practice guidelines ensure patients get the care they need

Bringing best practices together with an interprofessional approach sparks innovation in wound care

Project ECHO started in New Mexico in 2003, and today there are more than 220 hubs for more than 100 diseases and conditions in 31 countries. In Ontario alone, there are more than 300 community sites represented, and the newest hub, Project ECHO Skin and Wound Care, is the 16th tele-ECHO Hub.

The Project team is in regular contact with Dr Andrea Furlan and Dr Ruth Dubin, co-leads of Project ECHO Ontario Chronic Pain. In addition, Queen’s University, the educational experts for ECHO Ontario Chronic Pain, are important partners to Project ECHO Skin and Wound Care.

The project team has also been attending ECHO Ontario collaborative meetings and has been meeting regularly with the Project ECHO Mental Health team at CAMH.

The lessons learned have been fully integrated into the implementation methodology used in RNAOs Best Practice Service Organization (BPSO) Designation. Therefore, the specialty focus BPSO Designation, developed as part of this project, significantly augments the capacity of Project ECHO Skin and Wound Care to enable practices and organizations and implement wound care best practice guidelines (BPGs).

Wound care best practice guidelines include:

  • Assessment and Management of Foot Ulcers for Persons with Diabetes
  • Assessment and Management of Pressure Injuries for the Interprofessional Team
  • Care Transitions
  • Developing and Sustaining Interprofessional Health Care
  • Facilitating Client-Centred Learning
  • Person- and Family-Centred Care
  • Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients

Each of these BPGs contributes to practice interventions and inform direct patient care as well as enable better interprofessional practice and integrated health care in relation to wound management, including diabetic foot ulcers, across the sectors.

Skin & Wound Care Boot Camps for Spokes

Bringing together regional skills and teams to increase system capacity

Project ECHO Ontario Skin and Wound Care two-day in-person “boot camp” sessions are available to registered members. Watch for updates: we will conduct at least seven boot camps between 2019 & 2021 at the Michener Institute in Toronto and other locations across the province.

Boot camp sessions are deeper dives into Project ECHO Ontario Skin and Wound Care topics. The boot camps are developed and delivered in collaboration with the regional Continuing Professional Development (CPD Offices), and relevant program partners to improve regional relevance and recruitment.

The benefits of boot camps are:

  • Expand the cognitive, affective and psychomotor skills of participants through direct observation and hands-on on skills training
  • Promote professional networking and stimulate referral patterns across many disciplines
  • Connect interprofessional teams for coordinated, integrated patient assessment with feedback from patient volunteers and faculty on the patient care plans and team process
  • Identify system barriers to optimal wound care
  • Collect and reflect on outcomes information for quality improvement

Project ECHO Ontario Skin and Wound boot camps will be conducted in a similar fashion to the patient day at the current International Interprofessional Wound Care Course (IIWCC), which has been delivered at the Michener Institute since 1999. Even further value will be obtained by bringing together regional skills and teams in order to build regional referral patterns and increase system capacity.

A specialized curriculum and interprofessional approach

Here’s a curriculum example demonstrating the breadth of topics that will be covered

Project ECHO Ontario Skin and Wound Care curriculum is based on the International Interprofessional Wound Care Course (IIWCC). The IWCC is grounded in adult learning principles and designed for health care professionals with education and experience in the wound care field or related industry.

An example of the curriculum, set up as four sections (A thru D), each with 8 sessions, is below. To adapt to the specific needs of each cohort, there is some flexibility built into the curriculum; however, this gives you a good idea of the breadth of skin and wound care topics that are covered.

A. ADULT EDUCATION, WOUND BED PREPARATION, LOCAL WOUND CARE

A1. Adult Education and ECHO Basics

A2. Team Dynamics

A3. Navigating health care Systems

A4. Wound Bed Preparation holistic care paradigm (Sibbald et al. 2015)

A5. Treat the Cause – address the patient as a whole

A6. Patient Centered Concerns- pain, activities of daily living

A7. Healability- healable, non-healable, maintenance

A8. Local Wound Care – D.I.M.E.

  • Debridement, Infection/ Inflammation, Moisture Balance, Edge Effect

B. LEG AND FOOT ULCERS – INFECTION

Diabetic foot care and related foot ulcers

B1. Person with diabetes in general – Simplified 60-Second Screen, HbA1c, etc.

B2. Vascular Supply

B3. Infection: Surface Critical Colonization, Deep and Surrounding Infection

B4. Infection and the Diabetic Foot

B5. Plantar Pressure Redistribution

B6. Differential diagnosis of leg ulcers

B7. Venous and mixed Venous/ Arterial Ulcers

B8. Arterial and mixed Arterial/ Venous Ulcers

C. PRESSURE ULCERS, SKIN TEARS, MOISTURE ASSOCIATED SKIN DAMAGE, SKIN CARE

Pressure Ulcers

C1. The patient in general, Spinal Cord Injuries

C2. Classification of Pressure Ulcers and Differential Diagnosis

C3. Pressure Redistribution/ Shear

C4. Moisture, Nutrition, Mobility and other factors

C5. Skin Tears/ trauma

C6. Moisture Associated Skin Damage

Skin and Peristomal Care

C7.Skin integrity and principles of topical therapy

C8.Special considerations for Peristomal skin

D. SPECIALIZED WOUNDS

D1. Pilonidal sinus

D2. Hidradenitis Suppurativa

D3. Post-surgical wounds

D4. Burns and acute trauma

Palliative and malignant wounds

D5. Palliative wounds, skin changes at end of life

D6. Malignant wounds

D7. Lymphedema

D8. Acute Infections


More information about the International Interprofessional Wound Care Course can be found on WoundPedia.

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