Routine Rechecks

The routine recheck policy serves two purposes: (1) professional cleaning and redressing of the wound and (2) early identification of bleeding or wound infection. Routine rechecks have been criticized because: (1) most wounds are uncomplicated and do not require professional cleaning and redressing; (2) the routine recheck is usually performed at 48 h, slightly before the 3- to 5-day peak incidence for wound infection; and (3) the vast majority of wounds heal without complication and do not benefit from a recheck.

A more appropriate approach would be to implement selective rechecks on patients with complicated wounds at risk for infection. Comorbidity status and social situation may also be used to select patients for recheck. Patients may not have a clear understanding of the symptoms and signs of wound infection. Those at significant risk should be told to return on a specific day. Practically speaking, rechecks are easier when they are scheduled in the morning, when the ED is less busy and these patients can be seen expeditiously. Since the bulk of eD wound care is provided in the late afternoon and evening, having the patient return on the second and fourth day corresponds to rechecks at approximately 36 and 84 h. The first recheck would be appropriate for redressing and the second would occur when signs of wound infection usually become manifest.

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