Pivotal Improvements That Have Led To Increased Efficiency And Quality Care

William Fishco DPM FACFAS

I want to share with you some of the greatest improvements I have implemented in my office that have changed the way I practice podiatry.

Technology has played a tremendous role. First and foremost, the use of electronic medical records has been extremely helpful. Information is easily accessible wherever you have Internet access. No more carrying armloads of charts to dictate at home. No more garbled dictation tapes that the transcriptionist cannot decipher. No more buying cases of copy paper. No more storage space needed for files. No more trying to remember the details about Mrs. Smith who calls you at home with a problem after hours. The benefits are endless.

The Internet has facilitated other important improvements for the practice. Our practice’s Website educates prospective patients on what services I provide. The Website contains information that people can obtain without calling the office. This information includes directions, hours of operation, insurance plans we accept and, most importantly, downloadable new patient forms. I have found that patients will be more thorough with their medical history if they can fill out the forms at home without the rush of doing this in the waiting room. I also have post-surgical instruction sheets and educational materials that can be viewed or downloaded from the Website. If a patient forgets to pick up soaking instructions after a toenail procedure, we can direct them to the Website for the instructions.

Emphasizing The Value Of Digital X-Rays

I have had digital x-rays in my office for more than six years now. When I purchased the equipment, the technology was fairly new for office-based practices and thus very expensive. Despite the cost, it has been worth every penny. I do not think anyone enjoys cleaning the calcium buildup on the processor rollers or changing the chemicals in the tanks. I do not know about you but it seemed like the chemicals could really go bad almost overnight and then the X-rays would be too light to interpret anything. That is when you are scrambling to get your back office assistant to try to change chemicals at the same time you are trying to treat patients.

In addition to the obvious advantages of money savings over time (since it costs nothing to take an X-ray), patients are impressed with the technology. I explain to my patients that the technology is good for the environment as we no longer have to use chemicals with these X-rays. Each of my treatment rooms has an all-in-one computer hanging on the wall so I can review X-rays with my patients and have all of their medical records available. I find that having X-rays in the treatment room helps with the educational process that occurs during the patient encounter. It is simple to make a copy of X-rays for your patients on a CD.

I also take a CD to the hospital for my surgeries and do not have to worry about leaving the films on the view box in the operating room. The other benefits that I have found with digital X-rays include: the ability to adjust the contrast of the X-ray; being able to draw angles and make measurements; blowing up an image without losing resolution; e-mailing images to colleagues; and the ability to embed an X-ray into a PowerPoint presentation.

How Non-Invasive Vascular Testing Can Make A Difference

I introduced non-invasive vascular testing in my office about five years ago. I use BioMedix PADnet and have been very happy with the program. Basically, through an Internet connection, I can send the vascular testing results, both arterial and/or venous, to a designated reader who is typically an interventional cardiologist/radiologist or a vascular surgeon. If pathology is present, then I refer the patient to the appropriate vascular specialist who already has preliminary data on the patient.

Screening for peripheral arterial disease is paramount in patients with coronary artery disease, those with a history of diabetes and those with a history of tobacco abuse. The podiatrist should be the first line of defense in screening for peripheral vascular disease as many primary care physicians do not generally spend much time south of the belt line when examining their patients.

How many times during the day do your patients ask you about swelling in their legs and ankles? Rather than telling your patients to wear support stockings, now you can do a simple venous reflux test in the office and refer them to a specialist, who can offer various non-surgical and surgical treatments for their complaint.

I want to share a story with you. I had patient in her mid 50s who had a chief complaint of pain in the fifth toe. One may initially think of a hammertoe, corn or bone spur. However, when I looked at her toe, the skin had a cyanotic hue. After I engaged the patient in further discussion of her medical problems, she noted that she had severe back pain and had been getting epidurals, physical therapy and taking narcotics to control her pain.

To make a long story short, I suspected peripheral arterial disease. During the same office encounter, I performed arterial testing. The results were abnormal and I promptly referred the patient to a vascular surgeon. She was diagnosed with severe aortofemoral arterial disease and had, within in one week of being evaluated by her vascular surgeon, an aorto-femoral bypass. She came back to see me a few months later, hugged me and said, “Thank you for saving my life.”

The ability to direct patient care makes all the difference in potential outcomes. One could send a patient to the hospital for arterial testing and wonder if he or she actually follows through with this. Alternately, a patient may follow through with this but there may be a situation in which appropriate specialist care is lost to miscommunication. Why take these chances when you can facilitate everything through your office?

Facilitating Patient Comfort And Satisfaction

The very best thing I have done to enhance my practice was to buy land and develop/build my own medical building to my specifications. Just as new homes are built with an open floor plan, my office is very similar. I have oversized treatment rooms. Accordingly, when I am treating a little girl who has an ingrown toenail, her family members can be there with her in the treatment room. Windows with natural light also make the treatment rooms seem less institutional.

There is not one day that I do not get a compliment from a patient stating how he or she likes the office and says it feels very “comfortable.” Your patient satisfaction rate is dependent upon many things, not only quality of care, but their impression of your facility, staff and your bedside manner. As we all know, satisfied patients equal a busy practice.

Final Notes

All of these improvements that I have made do not directly make me more money, however, they do allow me to provide added services and offer efficient, quality podiatric care for my patients. After all, when the day is over, that is all that really matters.

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