This episode delves into the essential components that constitute effective referrals to wound consultants. Monika and Donna, advanced practice wound consultants and accredited lymphoedema practitioners, articulate the critical nature of comprehensive and precise information in wound referrals, emphasising that inadequate details can significantly impede the healing process. They explore the myriad factors influencing wound care while also lamenting the frequent absence of this vital data in referrals. The conversation serves as a clarion call for clinicians to prioritise clarity and completeness in their referrals, thereby ensuring a more streamlined and effective patient care journey.

Timestamps

00:00 Introduction

00:26 Competing echidnas and fun facts

03:56 Ponderings on what makes a good referral

06:30 Negligible value of a wound management chart

07:04 High value high impact information on a referral

09:45 The dream of an accurate and up-to-date medical summary

12:16 High value of knowing who is or was on the team

13:59 Yes patient/client goals by why did you want me there in the first place?

16:04 The systemic barriers to the perfect referral in non-acute settings

19:10 What do the key clinician think that they can’t say out loud or document?

21:30 Never too early to refer

22:10 Initial appearance of wound and rate of deterioration as a reference point

23:50 Bare essentials on a referral

20:15 How not to send a wound photo

26:33 When the quality of the referral reflects the quality of care

29:40 What other medical specialists have consulted

32:16 Does the wound probe to bone?

34:00 Presence and extent of cognitive impairment?

35:22 Foot wounds then who is the podiatrist?

35:46 Diagnostics

38:19 The golden elements of a referral

Endnotes

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The views expressed in this podcast are our own and is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures or refer to your healthcare provider for individual wound advice.

Welcome to the Tour Kidney Podcast from Advancing Wound Care, an online education platform for clinicians.

You're with Monica and Donna, two advanced practice nurses with decades of experience in hard to heal wounds burrowing into prickly conversations.

Welcome to the To a Kidney Podcast.

You're with Monica and Donna.

This will be a legs 11.

Number 11 it will be.

But first of all, I am very jealous because we had this sort of look, you're frowning.

I'm very jealous because we had, I think, this tacit competition about who would see an echidna in the wild first.

And you damn well got a selfie.

So tell us your story about the damn echidna.

Well, we did have a really good competition going, and I think it's become more serious than I first intended.

Well, absolutely.

So I was driving home not very long ago, and it was late in the afternoon and right in front of my house, and I live out in the middle of, you know, nowhere.

Yeah, there's something out there, but, you know, it may as well be.

And there was a gorgeous little echidna scurrying across the road right in front of me, making a beeline for the most unattractive dead tree weed.

It is a noxious weed in just off the side of my front, other side of my property that I have wanted gone for years because it's so ugly.

And now I love that bush and I don't want it to go because this little echidna lives under there.

So I jumped out of my wound one van.

For anyone who doesn't know my number plate, I have a special number plate custom plate.

And it's wound one because it's my work van.

And I slammed on the brakes, pulled over right in front and got.

Got a video as I went out and.

And chased this little guy up.

Actually got under the bush.

He wasn't running away from me.

He was.

Yeah, yeah, yeah.

But my other experiences, I've actually got two.

I'm kind of.

Oh, okay, one up on you now, aren't I?

Two up then.

Two up.

So we had some visitors from overseas.

And because our competition was to.

I should backtrack a little bit.

Our competition was to get a selfie.

Yep.

With the echidna.

And so I thought I was going to grab a selfie when that little guy jumped out down at.

At the front of my house, but he scurried into the bush before I could nab him.

And so we had some guests from overseas, some family, and they'll sing with us.

We're doing some touring around and we happen to walk up a mountain with bush on top of it and go up to the lookout.

We were looking at some of the monuments up on top of the lookout and we heard this rustling just over my shoulder.

And there you go.

He was a little good.

Kidna was there as well and he was having a fantastic time, was not phased by us there.

And he stayed there for at least 10 minutes.

Usually they do like the first guy, they run away.

But this little chap stayed and he came up to us.

He had a sniff around us.

He was busy, you know, trying to burrow and get things.

I think it had just rained so wither that.

How do you know it was something.

How do you know it was a male?

No, I'm completely guessing we do not know it all.

You can't.

No, you apparently can't.

It's only when they're in mating season that you can pick the males from the females because there's one female and there's 20, a trail of 20 males behind her.

So it's a Kidna train, I think.

Oh, well, there you go the trail and.

And they.

She picks by the one who stays around the longest.

Oh, there you go now.

Anyway, that's.

No, I think that's.

That's great.

It's a wonderful story.

But now goodness knows when I'll be able to see my first echidna in a while and get it in the kitten selfie.

I'll stop looking.

Okay.

So today we started talking about topics and tried to work out what are we going to talk about.

And one of the things that kept coming up was what makes a good referral to a wound consultant, what things we love about good referrals and what things we don't like.

Do you want to start, Donna?

There's a lot of places we could start.

I don't really want to start, but I will because I guess I have a referral system and I've been in a lot of places where we do take referrals across a lot of different sectors and I've seen everything from the A to the Z of referrals.

Now, I guess caveat, this whole conversation.

Yes, it's hugely important and makes such a difference to how the consultation or the whole process transpires.

It can be very stressful to put in a referral and very hard to know.

But you know, we need to say first off that there'll be differences between sectors, organisations, urgency.

You know, a lot of organisations will have templates and criteria.

So we are absolutely generalizing and There will be a lot of nuances, of course, referrals that are eligible, not eligible, etc.

So we're not talking about those specifics, we're talking about basic information, probably more clinical information.

That said, I'm going to start it right at the very beginning.

I've received referrals without a name, without an address, without a wound location.

Just can you go and see this person?

Oh, but here's the photo.

The quality of the photo may be, maybe is highly questionable, doesn't yield any and.

But they're very keen to tell you what dressing to put on.

So I'm always in private practice and having worked at tertiary centres and in clinics, for me I'm, I always have a wrestle between the need to make it easy to people or not prohibitive to refer to you because you know you can't be making, setting people up for failure.

But also what do you accept and at what point do you say that referral is not adequate?

I can't do my job unless there's a minimum amount of information.

I think we were talking about earlier today, I think the thing that gets my goat is not even my goat.

One thing that's a total waste of time as far as I'm concerned for everyone who sends a referral is when they send us, I don't know, 20, 30 pages of wound management charts that we just simply don't read because the information on there is either incomplete or there's dressing information which we generally are not interested in because they're often not evidence based dressings.

And that's a terrible thing to say, but that's what happens out in the clinical reality.

I get that all the time and have before.

But what I will get is the swab that was taken six months ago.

Oh, yes.

And that's sometimes when the GP's been asked to send the most recent bloods and that's what you get.

But I suppose the complexity too is even if we start talking about diagnostics and the diagnostics that we really appreciate on referral is, you know, again, the most recent bloods done and the most recent diagnostics X rays.

And people often think that if someone's got a wound, we're not interested in their chest X ray or the X ray of the knee.

But that all helps us form a holistic picture of what's going on.

Oh, for sure.

Even medications.

I have to remind people a lot for medications.

I mean, yes, you can yield that when you're there, but when that information is already available and you know, people are embedded in healthcare systems already, often by the time they come to us, we're not the first port of call.

You know, we shouldn't.

We should be able to glean that information, not have to go through everything for the 20th time with the patient.

Although sometimes you need to cover that off, of course.

But for me, it's really important to gather as much as possible, even though I will.

I will never not go and see someone.

For me, the more information that I have at the start makes the visit much more meaningful.

If you're limited for time, but not.

Information on a wound management chart, not on a.

Yes, yeah, I hate to say that, but there are a lot of wound.

Management charts out there that really don't give us much information.

Do you ever get the.

Yeah.

I could tell you what dressings we've put on, but we've tried everything.

Yeah, but again, that's.

It's also used.

It's not useful to us, or there.

Are no wound measurements, nothing that you can track the progression.

What did, what word did I say I used the other day?

Survival.

Wound survival.

That's it.

Yeah.

So it gives us no indication of wound healing or wound survival.

I often find people don't even know how long the wound's been there.

And talking about wound survival, we're saying, how long is the wound survived for?

Oh, a couple months, I don't know, a couple of years, not too sure.

But the patient knows.

So if the patient knows, why isn't.

Why don't we know?

And that has a lot to.

To say about wound recurrence, wound remission.

Because what I'm discovering, particularly with the work that we were doing in the vascular clinic, is that it's all good and well, someone comes in with a wound that is being poorly drained by the venous system and the generally phlebolymphatic wounds.

But if you don't intervene in that venous pathology, you're pushing the proverbial uphill because then they have to have compression all the time.

The bottom line is we actually have to send them off to get venous interventions done.

So what.

What do I want when someone refers to me?

I hope to get an accurate medical summary.

And that's a big call.

That is a very big call because.

Often the medical summaries aren't accurate in a hospital setting.

It depends on what CRAFT group has Completed the referrals as to what information you get, any X rays, any imaging, ultrasounds, bloods, recent bloods, even things like vitamin D. Now, vitamin D is becoming a very, very important hormone in wound healing and immunocompromised patients.

What else do I want?

Biopsy results?

Sometimes it's really hard to get those things.

In some situations, patients are being charged by GPS just to get blood results that I've requested, which is just unfair.

I have found previously when I've been in the initial workup, when in front of the patient and your family and you'll say, have you had scans done?

Have you had biopsies, done all of those diagnostics?

Oh, yes, I've had them done, or I think they've had them done, but nobody seems to know where the result is.

Like no one's actually they've been done, but no one's chase them down.

That can be really hard to put a finger on when they were done and it takes a lot of time.

But my concern is that when people are referring that they've not already asked those questions because if something is there, it should be included.

So I find I'm uncovering a lot of those at the first visit.

So I can see why it's hard sometimes to get those if I don't know about it.

But are people asking those questions initially?

Look, something else for me, as you were going through those things for you, I would 100 agree.

Irrespective of the setting of where I'm seeing someone, it's really important for me to know who are the other team members.

And even if that's been a continence nurse, they've seen it could be two years ago, they still likely are following some of those recommendations or have equipment from that.

So, yes, I'll certainly ask those questions when I'm there.

But it means that by the time you can get to do the assessment, you can have chased up previous reports or just get an idea of where you're heading.

So, yes, I want to know, is there an ot, Is there a physio?

How long has it been since you've had a dietetics review?

If at all has that been considered.

And what I find that often none of the above has been considered and that's where we'll often go in.

And that's the first thing we do is work.

You're right, work at which members of your multidisciplinary team have been involved.

And sometimes it's so formulaic the first thing is OT physio.

Dietitian, very formulaic.

It becomes, you know, to outsiders it looks like we're really the experts.

We're not.

We're just having to say the same thing over and over and over again, especially with pressure injury.

And there are many things that nurses can do in terms of prescribing equipment.

They're the first things we need in a referral.

You're absolutely right.

What other things do you look for in a referral?

My other big one.

And if people listen to me on socials, they'll know that I talk about goals a lot and barriers.

But there are two things I'm going to mention here.

I will talk about realistic goals, but what is that?

What are you wanting me there for?

So what, what is it?

Is even the goal of getting me involved because I can go in and without that just, you know, come and assess this wound.

Well, are you, I guess firstly, are you wanting a one off visit or you're wanting more support?

Who has initiated this?

I mean, look, even consent can be a problem.

What, what are you wanting out of this appointment?

Because different situations can want vastly different outcomes.

If I know that you're wanting wound healing and I can go in and within 5 minutes identify this is not a healing goal, that's going to make a really big difference to how I approach and handle the, the patient.

But see, you're bringing up a point there.

Because how many people say, yes, I want the wound healed, but you're going to heal my wound?

They actually abrogate their responsibility for healing.

I think goals, that's another topic.

Again, I'm gonna just park that.

But goal setting and wound, it's a.

No, it's a, it's a huge one.

I've been to places where they say, well, did you look at the other wound?

Like you never told me about another wound.

Like I'm really talking foundational stuff.

Yeah.

As well.

Like what's your primary focus?

What, what has driven you to want someone to go in?

You know, look, a lot of the time that's articulated well, but you can't assume anything.

And I think the more information the better because.

Let me, let me go back a bit.

Because when you get in there with the patient, often they can't recall everything.

Yeah, of course.

So you know, and it's information overload a lot of times.

So who's involved in the allied, what.

Are the goals and sometimes the things that we want on a referral, I'd like, like in a utopian world, you often can't get.

Because there are so many difficulties for clinicians to get them, particularly in a community setting.

Like gps don't communicate really effectively with district nurses.

District nurses don't effectively communicate back.

And then there's the allied health team in between.

Like communication pathways still, particularly from acute settings into community and back in and back are really poor.

So then sometimes you get lost in the patient's journey or their trajectory and that's really hard.

I really want to know, you know, as you were saying before, when did the wound start?

What made it worse?

And that's the thing that often you've got to really put your wound detective hat on.

And often wounds have got worse because of something that happened not just the day before, but either a week or two weeks beforehand.

You know, either they'd stopped wearing their compression or they'd had a chest infection or they had a severe bout of pain, or they decided to do a trip, you know, from a regional environment in the car for a long period of time down to a metro environment.

That's what you want to know.

And that really is often the reason why the wounds deteriorate in the first place.

And the thing that's triggered the referral to you, but time, multiple team members, it gets all lost in that.

And so often we go in there and try and dig that out.

But ideally that's what I would love.

And you know, often I say to people, if people make a choice to do something, for example, they've got a wound on the plantar surface of their foot, the bottom of their foot, and they decide to wear those cute little shoes just for a little trip down to the theater, you know, down to metro area Melbourne.

Expect that that wound in the next week or two will probably deteriorate.

And so it's not something that happened the day before that caused the wound to deteriorate, but something that you did or didn't do one or two weeks previously.

Yeah, absolutely.

I'm hearing you regarding the challenges in non acute settings to gather a lot of that information.

And you have, and it's, it's, it's, we're saying it's tough for us not having that, but it is tough for the clinicians as well.

Absolutely.

So we do know that and you have to prioritise where you're going to put your time to gather information.

So we absolutely understand it.

But I guess in referrals I would like to, to know what you haven't been able to get because, but so that maybe I can chase it.

But the other thing that I.

And that's hard to put down if people are filling in a referral form and usually there's some form of paper referral, that system that exists.

But the other thing I would want, I want to know that is really probably hard to put on a lot of templates.

It doesn't always exist.

But what does the key clinician or key group of clinicians who are involved with that, a referral and patient.

What do they actually think I wanted that they can't write down, is what I'm saying.

Because, yes, I can get to even the third or fourth visit and I'm still working the person up because, yes, I'm prioritizing.

What information do I need to get first, what's my second tier, third level of information, that type of thing.

And then there'll be a casual conversation or, or it might be that I've met a nurse or happened to be chasing a bit of information.

So I'll talk to them on the phone and they say, yes, look, I'm really glad to speak to you.

You know, other people put in the referral.

I'm just making an example here.

Right.

But did you know that XYZ is happening in the background, like.

Well, no, I didn't.

Because if no one's told me, how would I know?

And so usually something that's really key to do with why the wound's not healing or why it could be there in the first place.

Absolutely.

Like you said, they've put the little ballet FL on and spend all day walking.

But not, you know, I'm not going to.

Sometimes you don't yield that when we're doing our normal line of questioning.

So I want to know if there's things like that that we should know that don't fit into a nice little neat template when people are sending off a referral.

Or what about the things, again, that you.

Even if there was a template you couldn't put on the referral, like Company X came through, gave education on their product and now every single person with every single wound is getting that product from their wounds.

We're never going to yield that from asking a question message love you'd on a referral.

Wouldn't that be.

I mean, I suppose we talk about realistic referrals and then, you know, utopian referrals.

Absolutely.

Yeah.

But look, isn't it good that we can drill down to.

To find that just.

But it does take us time and I guess that really goes to show that when people are often referring to us and they.

They're in a desperate situation.

And usually people do wait till desperation point to refer.

We would love to get referrals earlier.

You know, that's really hard.

Yes.

The timing.

But when they're in that state, they're not thinking about those nuances.

And they want a solution to the problem.

Of course they want a solution to the problem.

That's why they've called us.

But it's not about the dressing.

Often a lot of these things don't come down to the dressing, but that's the information.

The, you know, 50 to 60 to 70, 80% of the information that we're getting in the referrals, like the photocopied wound charts.

I also want.

Here's another one that's hard.

It's a.

Probably a bit of a barrier, but something I will chase.

I want to know how long that wound's been like that.

But what did it look like a month ago, two months ago?

Like, how did it.

How did this wound evolve, particularly with the pressure injury?

What did it look like or iad?

What did it look like initially?

How quickly did it break down?

What was the color of the skin?

And again, you can't put that into a neat little template or ticker box type of setup.

And the places.

Too much demands on clinicians.

Oh, it does.

But those things we don't take for granted.

And I guess it's why when I've.

I still have a lot of people in.

In our.

My private practice who we end up keeping on and just see them during flares when something starts to break down or recurs again, is expected to do that.

I want to get onto it straight away as soon as there's an initial change.

So I can see how that skin injury is evolving in the early stages because it gives me clues into things like pressure, friction, shear and moisture.

What were those.

What is the driving forces that caused that wound?

Because I think often a lot of that really nuanced information is in the early stages and we just see a big ulcer by the time we get to it.

And it can be tricky, but, yeah, they're all the really tricky things that I would love to know that.

Yeah, it's hard, I suppose, like, ideally.

Name, address, Primary doctor.

Preferred name.

Preferred name.

Yep.

Primary doctor.

Where the wound is.

If you can tell us what you think has caused it.

Etiology, great.

But sometimes everything's called either a pressure injury or if we're lucky, a leg ulcer or a leg ulcer.

Yes, leg ulcer.

Don't mind people saying we're not sure or unconfirmed yes.

Or suspected.

Yes.

So the location.

And also if there's more than one wound, where are all the wounds?

Because you're right, sometimes you come across some amazing wounds in different parts of the body.

Something when you went and visited them and they said, oh look.

Oh, by the way, can you have a look at this wound on my husband, he had a skin cancer.

Taken off the top of his head.

Take it off and you're seeing bone.

Absolutely.

And that wasn't the reason why he was sending.

No, exactly.

Or wasn't the wound of focus?

No, no, it was a.

Was it a foot wound?

Yes.

Pathology imaging, that's all that I want for the bare bones.

And then we go in there and do the detective work.

Yeah, yeah, that sounds pretty good to me.

Don't Give us as 25 pages as.

You're right, I forgot the photocopy bit.

A black and white wound photo, I have to say, completely useless.

I'm remaining calm.

It is completely useless.

I forgot about that.

Also, when you embed the image, you don't send the attachment of the photo, but you embed it in the email.

Yeah.

And then you can't actually expand it or you know, to, or zoom in on it to have a good look at the wound as well.

But yes, a black and white photo.

Yeah.

And pages and pages of black and white photos.

Oh yeah, been there.

Absolutely had that.

Yep.

And, and, and, and still faxes, faxes.

Yeah, I haven't, well, I haven't had a fax for a while.

But yeah, it's a bit like the faxed photo.

It also useless.

Yeah.

It tells us a lot about the history taking and to me that this is not information for the referral, but it does the quality of a referral and that really good information.

Sometimes it depends on.

Okay, they'll give you what the fields are showing.

So you know, they'll give the bare bones that way.

So it's not always on the clinician that way.

Sometimes the system might not lend itself to that, but sometimes that's a phone call or, you know, where we can find that information.

Information.

But you know, I, if, if these are the people, I, I don't want to speak negatively of anyone.

I really, really don't.

But if, if we're getting, and I'll give you a story of why I'm saying this, if we're getting a really awful referral and also when you, you know, the documentation is really sparse when you get there, it honestly gives me an inkling or a clue as to what Some of the problem has been in the wound.

And here's the story as it goes for me.

I went to, it was quite a long time ago.

I went to see a new assessment.

I had received a written referral and yes, there was some comorbidities and all the generic information on there and the wound had been there for two years in the gaiter area, but it was very close to the medial malleoli and it presented as mixed.

I mean, mixed as in everything was mixed in there.

It wasn't to one or two disease processes.

But as part of my physical assessment, I asked the patient if I could, as I was measuring the leg, if I could also have a look at her other leg.

I wanted to assess the other foot and compare it to the contralateral side.

And she let out a roaring laugh and threw her orthotic leg or artificial leg up on the table in front of me and it was quite loud and said, yeah, well, good luck trying because I had an above knee amputation 10 years ago.

Now this was a person who'd been seen by the service for over 12 months.

It was not.

I went through the history from start to end and it was not written in the history anywhere.

So how can people give us really good.

That's like key, you know.

She was an above knee amputee.

Yes.

And that had a, you'll know that had a lot of clues as to where I needed to send this lady next and what the investigations were and what the etiology was of the wound, of course.

But that, that really scared me.

Like in all seriousness.

Yeah, that was, it was, yeah, it was a real standout case for me about, you know, you can't assume anything.

I would have loved to have known she was an amputee.

And, you know, that's very interesting because then I think about the referrals.

We used to get into the FASC clinic and just go running through some data at the moment.

And it was amazing how many times, even on medical summaries it wasn't written that the person had either a minor amputation, but even major amputations really not even written in the medical summary.

And so look.

Yeah, you're right, it's not that it's.

Well, of course we can be critical of, of any colleagues, I suppose, but at the same time, you're right, there are a lot of systemic issues.

Any other things that we want in a referral?

Here's another one.

Not so much in the referral, but when we get there and you touched on it before, what other Specialists.

Have they seen.

Because you go in there.

Oh, yeah.

They actually saw a dermatologist.

Oh, they saw a dermatologist.

Or where they went down, saw the vessel, the.

The vascular surgeon.

Oh, okay.

And then what did the vascular surgeon say?

Well, we don't know.

And this is the issue around surgeons communicating with GPs and that inherent systemic problem.

And that really has to be fixed.

It makes it so hard for clinicians.

Yeah.

We're working in silos.

Oh, I know.

I don't believe that.

Oh, getting people up to Mars.

And we've got the.

What is it?

James Webb, all those telescopes or not telescopes, but, you know, technology.

And we can't even.

A specialist to speak to a GP who speaks to then the treating team.

Yeah.

Yep.

Wounds do fall through the cracks like that.

Yes.

There's bigger issues like that, but, you know, where there's grinds in the system and wounds just seem to fall into all of those because they just get left.

And until.

Yeah.

We walk through the front door or the door in.

Try to piece that all together.

Sometimes I never know.

It's.

It is really hard, like.

Yes.

All that information.

I never know the level of questioning and where I'm going to often go when I get in the house.

And it can go to places that I didn't think of.

I do have a lot of situations where I've done an assessment with a nurse with me, which is always really useful and I think assists their professional development as well.

But when I'm finished, the nurse will comment.

I've been looking after this person for a long time and they never told me that.

Yes.

And so that's why you can't assume that we don't need to know some information because it might lead us down a path.

Yeah, but.

But we also, being consultants, have the luxury of time.

We've got a lot more time.

We do.

So that.

I think it's a tough call.

I think.

Yeah, it is.

It is a tough one because you.

Start developing that therapeutic relationship, you know, sometimes.

But that's why we dig, Bon, isn't it?

We're talking about a kidneys.

That's why we dig.

We'll just have a suspicion that there might be something in a particular area and we dig further and we scratch to go down that burrow because there could be some really useful information down there.

As you were talking, I thought about another thing.

Oh, yes.

This is another thing.

Okay.

So I suppose it's about identifying what are the biggest risk factors for that person and their wound.

So if, for example, I'm getting a referral for a pressure injury or a person who's got a wound on their foot.

One thing I do want to know is whether it probes to bone.

It's such an important thing.

For example, if you're going to send me a referral with a wound that probes to bone, don't worry about sending me anything else because first of all, I'll prioritise, you know, if anything, I'll say, get them to hospital.

Often it's.

Don't even.

Don't bother referring to me.

Send them to ed.

And that can expedite care very quickly.

So, yeah, it's a shame you don't actually always see that on wound charts,.

Whether.

A wound probes to bone.

No, I struggle to have seen that.

Yeah.

And as a consequence, people often don't even consider probing the wound and really checking the depth of the wound.

Not at all.

But, yeah, that's something that I'd like.

Just thinking about what I'd like on referral.

Yeah.

I suppose we're mixing between what we want on a referral and what do we want when we get there?

So let's just break that down because I think we've had a lot of content.

So let's go back to what's the bare bones that we need on a referral?

I'm going to add a bare bones one and it's probably because of the space that I work in.

Are there cognitive or communication deficits from the patient and.

Or family?

Yes, because we often feel as though.

Or I do.

My hands are behind my back when I do some of this work, because I have a sole practitioner as well.

So we'll go.

You often don't have a nurse with me and that could be whether it's in aged care or a home setting.

And I actually can't tell.

Oh, yeah.

Without doing further assessment.

Well, I know that there can be a level of cognitive decline or memory loss and often that's known, but it hasn't been communicated.

So how.

How can I gather information in that setting?

Yeah, because you don't have.

Yeah.

So, yeah, back to that question that.

I think that's a key, actually.

It's not often written, is it?

No, it's not written.

Not even on the medical summaries.

But we do.

Not always.

But it gets missed.

Yeah.

Yeah.

So back to your question.

In summarising the key stuff.

Bare bones.

Well, obviously, we want demographic information.

Yep.

And again, I still think I want to know who the key medical professional is in that team.

Absolutely.

If that person's got a wound on their feet, I want to know who is their podiatrist.

And in a community setting, I want to know whether that's a podiatrist whose main focus is on foot and nail health rather than high risk feet.

Yeah.

So that's sort of the bare bones there.

And then blood results, any biopsy results?

Biopsy results from any time, really.

Blood results, less time critical.

Yeah.

Biopsy, less time critical, I think, or depends on the circumstance, actually, but blood results, you know, if.

If they've got an infection.

If we're questioning whether they've got an infection, I don't want the FBE from six months ago.

No, no, no.

Six months ago isn't useful and I.

Don't want to CRP from six months ago.

Or maybe, but no.

So it's more recent bloods, you know.

Well, let's give them some.

Let's.

What about some guidelines?

Well, it depends on circumstance.

You can't really say no.

I'm chewing it over in my head.

That's why I haven't thrown out one.

I'm thinking of extremes.

It depends what you're looking for, but.

Yeah, but then again, you know, for a lot of community people, more.

If that's been.

If six months has been the last time they attended the doctor because the GP's not involved in the wound management and they would prefer not to go, or maybe they'd have a regular gp.

There's a lot of reasons why someone won't go.

That might be the last one that they've got.

Or they go in with inflammatory dermatitis or could very well be cellulitis.

And you ask them, did the.

The doctor run any blood tests?

No, no, but they do just run antibiotics.

Yeah.

Did you feel hot fluid?

Well, yeah.

Unwell, Myalgia, aches and pains?

No, the doctor put me on antibiotic.

Yes.

But I still think pathology imaging, anything.

If you think that even though they've got the wound on the tippiest.

Tippiest, most distal point of their foot, it's still important.

If they've had a brain ct, it may guide us.

As you were talking about any cognitive impairment or any acquired brain injuries that they've received, or migraines or, you know, terrible headaches that really impair their decision making, you know, they.

Yeah.

So that gives us even an idea of why they've got a wound on their foot.

So anything like that.

So I think that's about.

That's about wound referrals.

Okay.

All right.

Wrapped up so in summary, I would prefer 40 pages of fuzzy, out of focus, photocopied in the old fashioned way, almost unintelligible.

Yes.

Image results of imaging, blood results, any.

Any testing that that person's had, any specialists they've been to, any specialist report that you can actually get your hands on, rather than 40 pages of wound management chart that I never ever read.

Yep, absolutely.

I. I will read a very long geriatrician report before any.

I won't even look at the wound chart.

Yeah, they're quite gold.

So, yeah, all of those reports are gold.

Yeah.

So hopefully people have got the idea.

About wound management for charts for sure.

So thanks for listening in to this episode.

Episode.

We're sure that there will be some food for thought in there around referrals and acknowledging that everyone does have different limitations and different systems to do that in.

But spare a thought for the person you're referring to.

Yeah, yeah.

And.

And everyone knows the context that they work within.

And yes, it's all good.

It's all good and well for us in our ivory towers.

Well, not ivory towers, but in our positions to be saying what we'd like.

We're not working right in those environments.

We're always coming in as the experts to advise.

But at the same time, there are many things that we can see that can actually simplify workflow, especially around Moon management.

Absolutely.

And we don't want to assume that everyone actually does know what we do because that does have happen a lot.

That will turn up.

And they say you're here to do the dressing.

Well, actually, no, I'm not here to do the dressing.

No, I'm here to assess the patient and the wound.

So that's why we have covered off on a lot of this referral information.

Thanks, mom, for another great episode.

Thanks, Donna.

We'll see you in the next one.

Okay, bye.

Bye.

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