Noninvasive Wound Closure in the Emergency Department

Emergency department (ED) providers spend a significant amount of time treating low-acuity medical conditions, such as simple laceration repairs. Lacerations account for 5% of all ED visits in the United States (Centers for Disease Control and Prevention, 2016). An extended period of time by the provider is required for traditional wound repair, and there is perceived pain reported by patients (Song et al., 2017). The closure devices (Zip Closure device) are a latex-free, noninvasive alternative to staples, sutures, and glue and make wound closure an easy, fast process, allowing patients to remove the device after the wound has healed. The purpose/aim of this quality improvement project was to implement and evaluate the effectiveness of a noninvasive wound closure technique in the ED. The specific aims were to determine whether the Zip Closure device resulted in cost savings for the facility by decreasing the provider time that was needed for the laceration repair and determine whether there was an improved patient satisfaction compared with traditional wound closure methods. Following provider education regarding the use of the Zip Closure device, the device was available to providers over a 4-month period of time for use with patients in the ED. There were 63 lacerations seen in the ED during the 4 months of the quality improvement project, and an evaluation note was completed by a provider on all wounds. Six subjects were treated with the Zip Closure device, and 5 expressed satisfaction with the device. Providers stated that barriers to using the product on more wounds were that the lacerations were nonlinear, complex, high tension, and superficial or involved the finger, hand, scalp, face, or mouth; therefore, the device was inappropriate for treatment of the laceration. This was preliminary work of the noninvasive wound closure device. It is recommended that the study be repeated in a larger ED setting.