IRQ Articles

Practice management of wound care 

01-11-2019 13:57

A companion article to "On the cutting edge of wound care"

By Omosalewa Adenikinju, MD, Robert E. Beasley, MD, Timothy Yates, MD, and Brandon Olivieri, MD  e-IRQ exclusive

How did we do it?

To paraphrase Paul Michael, MD, “cosmetic angioplasty” might make the operator feel better, but it does not heal wounds. Of course IRs are capable of achieving masterful technical success, but clinical success is often not the same. This naturally requires a more holistic approach to wound care. In our practice, CLI management was never separated into revascularization and wound care; they are each other’s yin and yang.

At Mount Sinai Medical Center, Florida, Dr. Beasley realized this early on, and created a wound care center in continuity with his IR office to improve patient flow. This approach allows for regular and real-time wound healing assessment between multiple critical consultants (wound care, podiatry, vascular surgery, cardiology and IR). Now he and his partners see patients throughout the entire process.

Where do the patients come from?

Early on in our group practice, many patients came from the hospital. As our recognition of vascular insufficiency wounds became more honed, consultants recognized the unmet need we sought to address and thus the number of patients we saw increased. With improvements in hospital length-of-stay, decreased ischemia complications and overall reduction in major amputations, it became apparent that there was a benefit to this relationship. Local outreach has involved frequent communication with referring providers, with concurrent monthly lectures to patient groups at community centers. We have found that patient empowerment is critical to good health care insight and outcomes.

To manage a successful practice, we believe you have to OPT-IN:

Own the wound: If you as an IR want the wound to heal, follow it from initial consultation to complete healing. In this process, it is important to be aware of all factors affecting wound healing, from pathophysiology to medical and therapeutic interventions. Commit to healing it.

Partner: Recognize and partner with primary care, endocrinology, cardiology, podiatry and vascular surgery. This cannot be emphasized enough. Referring physicians must receive a valuable service from us. To understand that value, their patients always need to go back to them. This will make your referring physician as much the hero for successful limb salvage as you, because they had the wisdom to seek appropriate consultation. This is how you build a team, and that’s what heals wounds.

Tag team: To optimize patient care, the patient should follow up with both podiatrists and IR (at minimum) closing the consult loop in collaboration. Send photos and videos through secure channels to monitor progress and to provide feedback.

Initiate: Educate your local patient and medical community about what you can do. Present an unmet need. Make them aware of your simple and complex techniques, as well as about your outcomes. Pick up the phone and reach out to referrers and consultants to discuss patient progress (pre- and postprocedure). These conversations translate to patient and physician awareness, resulting in a bustling practice devoted to wound healing. Here are five handles to a successful wound care practice.

  1. See and follow your patient. Document encounters.
  2. Take off the dressing and photograph the wound (this will help you determine outcomes temporally).
  3. Call your referrals, always—whether with good or bad news.
  4. Call appropriate consultants—podiatry and vascular surgery.
  5. Ameliorate risk—endocrine, cardiac.

 Never give up!

Read the original wound care article.

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