The Specialty Gap No One Talks About: Virtual Wound & Ostomy Expertise for Rural Hospitals

Katherine Piette

Rural hospitals have increasingly turned to telemedicine to bring critical expertise to the bedside: neurology for stroke, cardiology for chest pain, psychiatry for behavioral health crises, and intensivists for high-acuity care.

These services are absolutely essential. But the conversation too often leaves out another specialty gap - wound and ostomy expertise.

Wound care is not viewed as a medical specialty in the same way as cardiology or neurology. As a result, it is rarely included when hospitals discuss “virtual specialty consults.” Yet the clinical need exists and is recurring and consequential, particularly in rural and Critical Access Hospitals that do not have a Wound Ostomy Continence (WOC) nurse on staff.

The issue is not that rural hospitals do not need this expertise. It is often simply overlooked and not named or listed as an option when hospitals consider virtual specialty support.

When telehealth organizations ask hospitals whether they need “virtual specialty consults,” hospital leaders often think first of physician services like cardiology, neurology, psychiatry, and critical care. But if the conversation shifts to “virtual WOC nurse support,” the need becomes instantly clear.

One Critical Access Hospital (CAH) CNO said it best: “Every time we get a wound patient, I hold my breath.”

That is not an exaggeration. A wound or ostomy concern can quickly become a clinical, operational, and financial challenge for a small hospital. Is a pressure injury correctly identified and staged? Is the care plan appropriate? Can the patient be safely managed locally? How does the care team manage ostomy challenges? Does the team have the right products and DME, and are staff documenting wounds appropriately? Or does uncertainty lead to a costly transfer?

Too often, the answer is to transfer not necessarily because the patient requires a higher level of care but because the local team does not have immediate access to the specialized guidance needed to move forward confidently.

Transfers are more than a transportation issue

For rural hospitals, transfers can be clinically necessary and lifesaving. But avoidable transfers create a series of consequences: delayed care, disruption for patients and families, increased transportation costs, loss of local revenue, and further erosion of confidence in the community hospital’s ability to care for complex patients.

Some of our rural partners’ data indicates that they lose as much as $1 million annually in avoidable wound-related transfers and outmigration.

That is meaningful revenue for any hospital. For a small rural facility operating on narrow margins, it can affect the ability to sustain services, invest in staff, and remain the trusted local source of care.

Virtual wound and ostomy expertise can help change that equation.

Expertise when the team needs it

A virtual WOC nurse is not a replacement for the hospital’s clinical team. It is an extension of it. With timely access to wound and ostomy expertise, rural clinicians can receive support for the following:

• Wound assessment, etiology, and pressure injury staging

• Evidence-based treatment recommendations and dressing selection

• Ostomy assessment, troubleshooting, education, and supply guidance

• Pressure injury prevention and escalation planning

• Documentation that supports continuity, quality reporting, and appropriate care planning

• Decisions about whether a patient can be safely treated locally or truly needs transfer

This support is especially valuable after hours and on weekends, when uncertainty can quickly become a transfer decision.

The goal is not to keep every patient local. It is to ensure that transfers are based on clinical necessity and not the absence of specialty support.

A practical model for rural hospitals

Rural hospitals do not need another expensive fixed-cost staffing model. They need access to the right expertise at the right time.

That may mean a virtual WOC nurse supporting an ED team evaluating a complex wound. It may mean helping an inpatient nurse determine the appropriate plan for a newly identified pressure injury. It may mean guiding ostomy care after surgery so the patient can remain close to home. It may mean providing education and case-based support that strengthens the confidence of the local team over time.

This is not simply a telehealth opportunity. It is a care-access and hospital-sustainability opportunity.

As rural healthcare leaders build their specialty telemedicine strategies, they should include wound and ostomy expertise. Not because it fits neatly into traditional definitions of a physician specialty, but because the patients, nurses, and hospitals who need it cannot afford for it to remain invisible.

The gap is not the need itself. The gap is in acknowledging that wounds are a medical specialty.