Healing Smarter With NPWT: Where Patient Outcomes Meet Economic Value, Part 2

In this episode, Jonathan Johnson, MD, and guest speakers, Cindy Miller, RN, and Ashley Collinsworth, ScD, MPH, highlight data showing that early initiation of negative pressure wound therapy with instillation and dwell—within the first day of treatment—can improve outcomes and reduce costs. Patients treated early had shorter hospital stays, fewer procedures, and over $10,000 in savings per admission. Tune in as Dr. Jonathan Johnson (Dr. Wounds) and guests discuss how optimizing timing can elevate efficiency and healing in wound care. 

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Dr Jonathan Johnson: Welcome to another episode of Wound Care Wednesday. We are your source for the latest evidence, innovation, and insight into wound management. I'm your host, Dr Jonathan Johnson, also known as Dr Wounds, and I have to say, grab your wine, your coffee, or your drink of choice. And wherever you are, tune in those ears for an excellent episode of Wound Care Wednesday. 

So, today, we're diving into an important clinical question: Does the timing of initiating instillation therapy make a reasonable and measurable difference in wound care outcomes and hospital costs? We'll explore the findings from a real-world retrospective analysis published in Wounds by Collinsworth and Griffin, which compared early versus delayed initiation of 3M Veraflo Therapy. The result showed that early initiation of Veraflo Therapy within the first day of negative pressure wound therapy with instillation and dwelling application was linked to shorter hospital stays, fewer debridements and OR visits, reduced readmission, and an almost an $11,000 lower mean cost per admission for facilities. 

So, with that said, joining me today are Cindy Miller, representing the clinical perspective, and Ashley Collinsworth, bringing insights into workflow and health economics. And together, we’ll unpack what these findings really mean for clinicians and institutions that are balancing outcomes, costs, and operational efficiency. So, with that said, let’s chat with Cindy. Cindy, tell us a little bit about the Solventum story, and tell me a little bit more about how Veraflo wound therapy is effective and works for our patients. 

Cindy Miller: Thank you so much, Dr Johnson. Solventum is a fairly new company. We've been a publicly traded company for about a year and a half now. And it's a combination of KCI—which people, if you do wound care, you've probably heard of V.A.C. therapy—and 3M therapy, who acquired us about 5 years prior. 3M spun off their entire division of health care, including their dental, and it became a publicly traded company. They took two words, solving and momentum, and they put them together, thus Solventum. So, we are a company that tries to solve with momentum. And today, we're going to talk about Veraflo Therapy, which is V.A.C. Therapy with the additional ability to customize an instillation of a topical solution, have it dwell at the physician's choice, and then turn back into V.A.C. therapy again. So, it's almost like a bedside washout, if you will. It's all automated and customizable.

Dr Jonathan Johnson: Nice. Okay. So, we're looking at a therapy that can be utilized, number one, to decrease costs, increase workflow efficiency, increase granulation tissue, and also really help us with the bio-burden issue. And those specific four concepts are really effective in the Veraflo Therapy clinical algorithm, if that's what you're saying, correct? 

Cindy Miller: Yes, sir. That is exactly right. Because when we see the majority of the wounds that you'll see in this study came in either emergently or urgently, and most of them were infected or had cellulitis. So, if we think about if you're going into surgery and you do the debridement or maybe you're delayed—the ability to cleanse that wound either before debridement or after debridement is something we really wanted to look at.

Dr Jonathan Johnson: Beautiful, love it, love the concept. I mean, heal rates are very important. We want to make sure we're actively treating our patients effectively so they heal in a timely manner. So, Ashley, before we dive into the data, can you share the background of this study and why the timing of this treatment initiation has become such a relevant question in wound care today?

Ashley Collinsworth: So, Veraflo was initially used in wounds that did not respond to traditional negative pressure wound therapy or maybe as a therapy of last resort. So, growing evidence of the therapy’s effectiveness has really led to the adoption of Veraflo as an integral part of wound care and a first-line therapy. And although there were guidelines that recommended the use of Veraflo as an adjunct therapy, along with debridement and antibiotics for a variety of wound types, questions remained about the timing of Veraflo initiation. No studies had examined the effect of Veraflo timing on clinical outcomes and cost. So, we designed a study to address this gap in the literature. 

Dr Jonathan Johnson: So, Cindy, tell us a little bit about some of the real-world practice variations when clinicians initiate Veraflo therapy. 

Cindy Miller: Thanks. That's such a great question. So, when we look at patients that are admitted to this database, these are the all-comers. This is whatever rolls into the ER is admitted directly from the doctor's office. And so, we look at what they actually choose at that time based on their clinical algorithm for that patient's recovery. And so, oftentimes, there's a trip to the OR for a sharp debridement. What we wanted to do was we wanted to look at when you initiate Veraflo Therapy, does that decision-making process impact costs, lengths of stay? And because that helps guide practice. We love to lean into the evidence to practice medicine. And so, that's what this was trying to do to see. Does it make a difference or not when you start it early versus late? 

Dr Jonathan Johnson: Makes sense. Makes sense. So, understanding more about the clinical treatment, is there a way to look at optimizing timing and how that can influence both outcomes and economics from an application standpoint? Tell us a little bit about that, Ashley.

Ashley Collinsworth: I think with this study, we were able to—we had access to charge data and we could see when the product was used. So, we were able to look at and see what day the patient received Veraflo. So, that really helped us divide our study population into 2 groups. And to that early—the group that had early initiation, so they received Veraflo within the first 24 hours of receiving negative pressure wound therapy versus the other group that received Veraflo much later, within 2 to 7 days of negative pressure wound therapy. 

Dr Jonathan Johnson: Got it, got it. So, second part question, Ashley, tell us a little bit about the design of the study, and what makes the findings credible in today's real-world context? 

Ashley Collinsworth: Absolutely. So, this study is based on real-world data obtained from the provision of routine patient care. So, although this study is not a clinical trial, these findings may be more generalizable to everyday patient populations than findings from a highly controlled study. So, we conducted a retrospective matched cohort analysis using the Premier Healthcare Database, which is the largest hospital administrative database in the United States. So, the database contains de-identified clinical and cost data from over 10 million inpatient admissions a year, which is approximately 25% of annual US inpatient admissions. So, the database is fairly representative of the US patient population.

Dr Jonathan Johnson: Got it. So, one of the major factors, obviously we look at health care in general, is cost. Help us understand the key clinical cost outcome of the almost $11,000 lower mean cost index of admission. How did we get to that? And how did we obtain that number specifically from the study? 

Ashley Collinsworth: Sure. So, we looked at and compared—we had access to the total cost of the index admission for these patients, so we were able to compare those costs, and that's where we see that $10,000—over $10,000 difference. And these observed cost savings were really driven by a reduction in the number of OR visits and debridements, a reduced length of stay, and less time spent on negative pressure wound therapy. So, ultimately, early initiation of Veraflo decreased resource utilization, which is really important to health care providers these days, obviously. And it's really hard to argue against early initiation of Veraflo, given these positive outcomes we've seen from this study and that cost reduction. 

Dr Jonathan Johnson: So, thank you for that point, Ashley. So, Cindy, let's talk a little bit about the impact of study results. What stood out about the clinical differences between early and late initiation of the Veraflo Therapy?

Cindy Miller: It's really interesting because it's multifactorial. When you look at it, there's so many angles that this addresses. We want our patients to do well. They've been admitted with a wound that is significant enough they're going in for surgical debridement. And we know from the historical, that you can go in and debride, but then that bioburden life cycle, we can't sterilize the wound. And so, we get this buildup, and you have to go back in oftentimes, as I'm sure you're aware, and do another debridement or maybe another before you feel that you can close the wound surgically or send them out for secondary incision healing. 

Dr Jonathan Johnson: The point about bioburden, Cindy, is key, but we can also look at OR efficiency and timing of clinical turnover. If we can make sure our patients are transferred from the OR to the stepdown unit effectively, it really helps with our patient flow. Tell us a little bit about how we can reduce those OR times and how we can adequately make sure our patients have what they need as they're transferred from the OR back to inpatient or back to wherever their place of service is. 

Cindy Miller: That's really an excellent point, sir. So, when we see a debridement on the OR schedule, it's typically an add-on. So, it's going to either disrupt your normal OR scheduling or have to run a room late or extra rooms depending on the size of the hospital. So, the ability to reduce that number of surgical debridements, the efficiency that this brings to the OR suites is really something that is easy to overlook. And that's what I like about this real-world data is it really looked at does—everybody in the study received Veraflo. So, the control was itself, was Veraflo that was initiated later versus earlier. So, I think it’s something that is underrecognized, and we hope that this will allow us to think a little bit differently about “Do I use Veraflo, and if I do, when should I start it?” 

Dr Jonathan Johnson: So, Ashley, we understand some of the key data points, which we discussed. Tell us a little bit about the matching side and how that really affects the foundation of the study. 

Ashley Collinsworth: We match patients on demographic, clinical, and wound characteristics, really in an attempt to create 8 equivalent groups, with the timing of Veraflo really being the only difference between those groups. So, use of matching makes it more likely that these differences that we observe between groups are due to the timing of Veraflo and not other patient or clinical factors. So, we were able to compare 514 patients, so 257 in each group, which is a fairly large sample size, who either received early Veraflo initiation or late Veraflo initiation. 

Dr Jonathan Johnson: Got it. So, the concept here is that the patients were not just picked randomly. This was essentially a retrospective matching cohort that really focused on the results that Veraflo Therapy shows. So, Cindy, help us understand the mechanism of action of Veraflo. How are we utilizing it from a periodic instillation format? 

Cindy Miller: Well, that's really a great question because the FDA has given us the indication that topical solutions or suspensions can be used to cleanse the wound. And so, at the surgeon or health care practitioner’s discretion, they can use anything from saline to hypochlorous acid to dilute Dakin’s, whatever they feel is appropriate. And then, they can adjust the timing. The unit is smart enough that it can actually calculate how much solution would be appropriate. And then, the clinician gets to choose “How long do I want it to soak?” and “How long do I want it to then turn back into the V.A.C. until it's time to cycle through?” It's an automated volumetric choice.

Dr Jonathan Johnson: Beautiful. And the instillation solution is variable based on what the clinician chooses from a clinical standpoint and what the wound is or is not responding to, correct? 

Cindy Miller: That is absolutely correct. There's a table that we can provide for anyone that's interested that looks at the solutions that are two things. FDA indicated, meaning it's not an antibiotic. It's antimicrobial or some sort of thing like saline. We've tested it to make sure that what is hung in the bag, once it goes through the system, will be delivered in a safe and effective manner to the wound. 

Dr Jonathan Johnson: Got it. So, the instillation solution is what separates the Veraflo Therapy from a normal negative pressure device.

Cindy Miller: Yes, they both operate as V.A.C. Therapy for the majority of the time, but with Veraflo, you have the additional option of cleansing the wound and then removing the exudate again. So, it's like washing your hands. It gives you the option to do what you want. 

Dr Jonathan Johnson: Great. Love that concept. Got to continue to wash the wounds. Remember, reducing the bioburden increases the amount of granulation tissue we can see, which increases our healing rates. So, we have an economic superstar in Ashley on the podcast today. And we did speak a little bit about the almost $11,000 cost difference in mean cost per admission, which is substantial. So, Ashley, tell us a little bit about the factors that are driving savings and how that translates to hospital and/or system-level decision-making.

Ashley Collinsworth: So, we saw a reduction of 3 days in inpatient stay length, and that's a big driver of cost, obviously. And then, we also see these fewer trips to the OR, so like 1 fewer trips to the OR, on average, a little over 1. So, that obviously reduces cost, reduces that resource use. And then, I think also if we think about the economics for the patient, that gets the patient back home, back to work faster, back to activities faster. So, I think there is value both from the health care system perspective and for payers. When we see that Veraflo is actually reducing this utilization and improving patient outcomes. That's just a win-win for patients and payers and hospital providers. 

Dr Jonathan Johnson: Great point. Great point. I mean, specifically when you're talking about cost savings for payers, I love that point because it's seldom discussed, but it's also an important concept in the overall health care algorithm. And we have to make sure there's cost savings across the board. So, let's switch gears a little bit, and let's talk a little bit about evidence in our clinical practice. So, for some of our clinicians that are listening, Cindy, how can these findings be applied in daily wound care workflows? Tell us a little bit about the initiation of the Veraflo treatment and how we can adequately use it for best results. 

Cindy Miller: One of the ways that we would consider doing this would be, it would almost be a quality improvement initiative where a multidisciplinary team gets together, leans into the data as evidenced in this paper, and then makes decisions about maybe there's a certain type of wound that we could identify that comes in, that we want to actually ourselves be able to initiate this protocol and see if it makes a difference in our own patient population. So, that's one of the things that I think is, rather than a haphazard approach, something that looks at all of those quality improvement measures that hospitals such as yourself are actually measured on in today's reimbursement. 

Dr Jonathan Johnson: I love that. And I think one of the major points for clinicians to understand is initiation of quality wound care treatments as early as possible is key to making sure wounds heal effectively and also a multidisciplinary approach. This is where we want to focus on educating some of our other colleagues that may not understand what Veraflo is and how to utilize it effectively. All right, team. So, from broader implications for wound care innovation. This is a question for both Cindy and Ashley. How does the data fit into broader evolution of the negative pressure wound therapy, specifically with the Veraflo treatments? And as it gains traction for wound bed optimization, how are we utilizing it effectively in the future of our clinical wound care medicine? 

Cindy Miller: What I think about a lot of times, since I used to work in the operating room, is that when those patients are admitted with a wound, specifically if the wound is the reason they're being admitted, they are dragging in with them all the bacteria of whatever it is that they have or —you know, many of these bacteria will be, they'll be polymicrobial. There'll be several in there, and they can be antibiotic resistant. So, the ability to put that wound in a closed-loop cleansing system, Veraflo, which is negative pressure with the instillation, I think when we start to recognize that until they get to the OR or even after debridement, this might be a methodology to really help us get that patient well, get the wound in the right trajectory. Then, we can discharge them home or to wherever they're going. 

Ashley Collinsworth: I think these data really track with existing research and emerging research regarding the benefits of airflow, especially when we looked at compared to standard of care, maybe even negative pressure wound therapy. So, we see these results are consistent across these studies that gives us confidence about the value of Veraflo. I think, and similar findings were even observed in a study looking at just standard negative pressure wound therapy, the early versus late timing of that. So, I think there's—the message is clearly that early initiation really helps improve these wound outcomes. 

Dr Jonathan Johnson: Love the concept. I think understanding, again, how effective Veraflo is in, number one, wound bed optimization, helping to remove and reduce bioburden, helping to increase OR transition efficiency and cost savings for health systems is definitely key. 

You guys have been awesome today. So, as we typically do with all our guests on Wound Care Wednesday, two-part question, last question. Number one, what is 1 takeaway question—or what is 1 takeaway point you would like clinicians and our listeners to understand about Veraflo? And the second part of that question is why are you passionate about wound care? How about, we'll start with you, Cindy? Take it away. 

Cindy Miller: Okay, so I think the 1 takeaway for me would be if you are a Veraflo user, you're using it to clean your wounds up. Maybe consider starting a little bit earlier if you use it when nothing else has worked. And secondly, if you've not ever used Veraflo Therapy, maybe you're accustomed to V.A.C., try it. See if it can work, help you get your wounds to the point that you're happy. You can close them surgically or you can transition them to another care setting. And why am I passionate? Probably my time in the OR and the ICU, and I see the pain and suffering that these patients go through and how it can devastate their life and their family's lives. The ability to provide clinicians' tools that they can use appropriately is what gets me up in the morning. 

Dr Jonathan Johnson: Love that concept. Love that concept. Ashley, how about you? 

Ashley Collinsworth: Sure. I would say, we tell clinicians, “Start smart with the Veraflo.” When you look at the evidence around Veraflo's effectiveness in cleansing wounds, managing bioburden, and promoting granulation tissue formation, it's really not surprising that early initiation of Veraflo is associated with better clinical outcomes and reduced care cost. And, you know, I enjoy doing research around that really helps patients, improve patient care. So, that's really where my passion lies and helping clinicians see what therapies are more effective than others and be able to implement those in their practice. 

Dr Jonathan Johnson: I love it, love it. It's always great to hear from our guests and panelists about their passion for wound care. We need to continue to perpetuate that as much as possible to all voices and to all audiences. And that was a powerful insight on how evidence-based timing can improve both outcomes and efficiency. A special thanks to our guests today, Cindy Miller and Ashley Collinsworth, for joining today's discussion and to Solventum Corporation for sponsoring this episode and continuing to advance wound care innovation. Now, for more details on the Collinsworth and Griffin study, and any related resources, visit our Wound Care Wednesday page. I'm Dr Jonathan Johnson, also known as Dr Wounds. Thank you for tuning in to another Wound Care Wednesday.