Assessing The Potential Impact Of HBOT For Your Practice

Jay G. Levine, DPM, and Bernie Chowdhury, BA, CHT

   An examination revealed the patient’s vascular status was acceptable. Her treatment consisted of surgical debridement with a midfoot amputation and a flap.

   The patient also received HBOT on her first postoperative day. She had hyperbaric oxygen at 2.5 ATA BID for five days and QD for 40 days. The patient later healed and was walking in an ankle-foot orthotic (AFO).

Case Study Two: Treating An Elderly Patient With Diabetes And Bilateral Forefoot Gangrene

A 90-year-old male presented with a history of bilateral forefoot gangrene due to peripheral vascular disease. He had non-insulin dependent diabetes.

   His treatment consisted of a femoral-popliteal bypass followed by a proximal transmetatarsal amputation of the left foot. He also had a revisional transmetatarsal amputation of the right foot.

   The patient received hyperbaric oxygen at 2.5 ATA for 40 sessions. He healed and began ambulating in an AFO and a diabetic shoe, and started exercising on a bicycle.

A Guide To Implementing HBOT At Your Facility

Private practice podiatrists can refer their patients to a local or regional hyperbaric medical facility where the patient receives treatment and the referring physician stays informed of the patient’s progress. For established wound care programs, adding hyperbaric chambers will likely enhance their program and increase the number of patients they see. For hospitals, adding hyperbaric chambers may mean the difference between reducing hospital length of stay and transferring their patients to another facility that offers HBOT on-site.

   Good Samaritan Regional Medical Center’s Wound Care Institute was operational for three years before we started looking into adding hyperbaric chambers. It was an involved process from beginning to end and required the expertise of an experienced HBOT third-party service provider. In our case, we brought in the Life Support Technologies group, a New York-regional HBOT and wound care service provider, to help us with all phases of HBOT implementation, staff education, compliance and national accreditation. It took us two years from initiating the process to full hospital administration and regulatory agencies approval, and treating our first HBOT patient.

   Good Samaritan Regional Medical Center has treated 160 patients with HBOT and its Wound Care Institute now sees an average of 50 to 65 podiatric patients weekly. The Wound Care Institute has become one of only a handful of facilities in the U.S. Northeast to be accredited under the nationally recognized Undersea and Hyperbaric Medical Society (UHMS) program.

   When adding hyperbaric chambers to any facility’s treatment options, physicians need to consider many things, the first of which is space. Requirements include a patient intake and waiting area, ample room for the hyperbaric chambers, a patient changing area and lockers, a patient examination area and, for clinical staff, lockers for their personal things. Ideally, the hyperbaric chambers will be located adjacent to or in close proximity to the wound care program. This will make physician supervision of HBOT far more practical and will save wear and tear on physicians who may otherwise have to travel from another part of the building to examine patients or deal with any potential complications.

   It is important to note that partnering with experienced HBOT practitioners makes good sense, particularly if you are just getting into the hyperbaric field. However, make sure that they will be providing comprehensive policies and procedures covering all aspects of the operation, from the provision of treatment to general safety and the management of adverse events that can occur just as they do with any modality one employs in patient care. The HBOT providers should also support you in dealing effectively with the fire marshal, your state’s department of health, engineers and the Joint Commission to create the physical space that is compliant with local and national codes, and the paperwork trail required by government regulations.

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