A Day in Mobile Wound Care: Case Study of 8 Visits

A Mobile Wound Care Day: Eight Patient Visits

What does a mobile wound care day actually look like? Not the business plan version with neat time blocks and perfect patient spacing. The real version, where drive times shift because of traffic, patients are not always ready when you arrive, and the wound you expected to debride turns out to need a full workup.

This composite case study follows a hypothetical mobile wound care NP through a day of 8 patient visits. All patient details, clinical findings, and scenarios are composite and hypothetical, created for educational purposes. No real patient data is represented.

Pre-Day: Route Planning and Supply Check

The day starts at 7:00 AM in the clinician's vehicle, which serves as a mobile office. Before the first visit, the NP reviews the schedule and route. Eight patients are scheduled across a service area spanning approximately 45 miles. The route has been organized geographically to minimize backtracking, with patients in the same neighborhoods grouped together.

Supply check: wound care cart is stocked with debridement instruments, dressing supplies (foams, alginates, hydrofibers, silver dressings, skin substitutes), NPWT supplies, wound measurement tools, camera with calibration markers, and a laptop for point-of-care documentation.

For a detailed guide on daily workflow optimization, see Wound Care Daily Workflow Guide.

Visit 1: 8:00 AM — Routine DFU Follow-Up (Home Visit)

Patient: Hypothetical 64-year-old male with a plantar DFU, week 6 of treatment. Offloaded with an irremovable walker boot.

Visit flow (25 minutes total):

Assessment (5 min): Remove boot and dressing. Photograph wound with calibration marker. Measure: 1.8 cm x 1.2 cm x 0.1 cm. Wound bed 95% granulation. No signs of infection. Periwound intact.
Treatment (8 min): Minimal debridement of callus at wound margins. Apply collagen dressing and non-adherent contact layer. Reapply boot with irremovable modification.
Documentation (7 min): Enter wound measurements, photograph, wound bed description, treatment performed, assessment narrative, and plan. Capture debridement CPT code with wound area documentation.
Patient education (5 min): Reinforce boot compliance. Review foot inspection technique. Confirm follow-up in 1 week.

Billing: E/M (established patient), selective debridement.

Visit 2: 8:45 AM — Post-Surgical Wound Check (Assisted Living)

Patient: Hypothetical 72-year-old female, 3 weeks post-hip replacement with a 4 cm dehisced incision on the lateral hip. Referred from orthopedic surgeon.

Visit flow (30 minutes total):

Assessment (8 min): Wound measures 4.0 cm x 1.2 cm x 0.5 cm. Clean granulation tissue throughout. No signs of hardware exposure or deep infection. Serous exudate. Photograph and measure.
Treatment (10 min): Gentle irrigation. Apply silver alginate primary dressing, foam secondary. Update surgeon via secure message with photo and measurements.
Documentation (7 min): Document wound status, treatment, surgeon communication, and plan. Note facility-specific requirements for assisted living wound care documentation.
Coordination (5 min): Brief the facility nurse on dressing change schedule between visits and signs that would warrant an earlier contact.

Billing: E/M (new patient), wound care management.

Visit 3: 9:30 AM — NPWT Dressing Change (Home Visit)

Patient: Hypothetical 78-year-old male with a Stage 4 sacral pressure injury on NPWT, week 8 of treatment.

Visit flow (40 minutes total):

Assessment (8 min): Remove NPWT dressing. Wound has decreased from 8.2 cm x 6.5 cm x 3.8 cm at initial visit to 5.1 cm x 4.2 cm x 1.4 cm. Granulation tissue filling from the base. No undermining remains. Photograph.
Treatment (15 min): Selective debridement of fibrinous tissue at wound margins. Cut and place new foam filler. Apply drape, connect tubing, verify seal at -125 mmHg. Confirm therapy is functioning.
Caregiver education (10 min): Review alarm troubleshooting with the patient's spouse. Confirm repositioning schedule compliance. Inspect heels for any new pressure injury.
Documentation (7 min): Wound measurements, NPWT settings, debridement code documentation, caregiver education note.

Billing: E/M (established patient), selective debridement, NPWT management.

Drive Time: 20 Minutes

The next two patients are in a different part of the service area. The NP uses drive time to return a call from a referring physician about a new patient referral, using hands-free calling.

Visit 4: 10:30 AM — New Patient Evaluation (Skilled Nursing Facility)

Patient: Hypothetical 81-year-old female with bilateral lower extremity venous stasis ulcers, newly referred.

Visit flow (45 minutes total):

Assessment (15 min): Full wound assessment of both wounds. Left medial malleolus: 5.2 cm x 3.8 cm. Right medial calf: 3.1 cm x 2.4 cm. Both with mixed granulation and fibrinous tissue. Bilateral edema 2+. Periwound hemosiderin staining bilaterally. ABI checked: 0.94 left, 0.98 right — safe for compression. Complete history including venous disease history, medications, mobility status.
Treatment (12 min): Debride fibrinous tissue from both wounds. Apply primary dressings. Initiate multi-layer compression on both legs.
Documentation (12 min): New patient intake documentation. Detailed wound descriptions for both wounds. Medical necessity narrative for compression. Plan of care development with 4-week reassessment timeline.
Coordination (6 min): Meet with facility wound care coordinator to establish communication protocol. Provide dressing change instructions for nursing staff between visits.

Billing: E/M (new patient, higher complexity), selective debridement x2 wounds, compression application.

Visit 5: 11:30 AM — Non-Healing Wound Reassessment (Home Visit)

Patient: Hypothetical 67-year-old female with a lateral left lower leg wound, week 6. The wound has stalled (14% area reduction). This is the beginning of a systematic non-healing wound workup.

Visit flow (35 minutes total):

Assessment (8 min): Wound measures 3.5 cm x 2.7 cm. Granulation tissue present but no epithelial migration. Review prior visit measurements to confirm stalled trajectory.
Clinical decision (5 min): The 4-week healing threshold was not met. Initiate systematic workup: order ABI with toe pressures, nutritional labs (albumin, prealbumin, vitamin D), HbA1c. Perform tissue biopsy for culture at this visit. Plan wound edge biopsy at next visit if labs do not reveal a clear barrier.
Treatment (10 min): Tissue biopsy obtained. Wound debrided. Standard dressing applied.
Documentation (7 min): Document clinical rationale for workup initiation. Note prior trajectory measurements supporting the decision. Document biopsy specimen handling and lab order placement.
Patient education (5 min): Explain the workup to the patient. Address concerns about the biopsy. Confirm lab draw appointment.

Billing: E/M (established patient, higher complexity due to clinical decision-making), debridement, biopsy.

Visit 6: 12:30 PM — Working Lunch and Administrative Tasks

Duration: 30 minutes. The NP parks and handles administrative tasks while eating:

Review lab results that arrived from this morning for two other patients.
Respond to a prior authorization request for a skin substitute application planned for a visit later this week.
Call a patient's pharmacy to clarify a medication interaction question.
Review the afternoon schedule and adjust the route for a patient who rescheduled to a later time.

For strategies on route optimization and time management, see Wound Care Route Optimization.

Visit 7: 1:15 PM — Skin Substitute Application (Home Visit)

Patient: Hypothetical 59-year-old male with a chronic DFU, week 8 of treatment. The wound met criteria for skin substitute application based on the 4-week trajectory assessment.

Visit flow (35 minutes total):

Assessment (5 min): Wound measures 1.9 cm x 1.4 cm. Clean granular bed. No infection. Offloading device intact and in use.
Treatment (15 min): Sharp debridement to refresh wound bed. Apply skin substitute per manufacturer protocol. Non-adherent contact layer, moistened gauze bolster, foam secondary dressing. Reapply offloading device.
Documentation (10 min): Document debridement, skin substitute product lot number, application technique, wound bed preparation, and medical necessity narrative. Confirm prior authorization is on file.
Patient education (5 min): Instruct the patient not to disturb the dressing for 7 days. No weight-bearing on the affected foot for 48 hours. Contact the office immediately if pain, odor, or fever develops.

Billing: E/M (established patient), excisional debridement, skin substitute application.

Visit 8: 2:15 PM — Wound Care and Palliative Goals (Home Hospice)

Patient: Hypothetical 89-year-old female with end-stage COPD on hospice, presenting with a Stage 3 sacral pressure injury. The wound care goal is comfort and infection prevention, not closure.