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.