What You Should Know About Starting A Wound Care Clinic
A: Dr. Suzuki cites the efficacy of hyperbaric oxygen therapy (HBO). He says “having a HBO clinic within or near your clinic is enormously helpful, especially when limbs and toes are critically infected or ischemic (i.e., severe diabetic foot infections and traumatic amputations).” Dr. Fife also uses HBO therapy.
Negative pressure wound therapy devices such as VAC therapy (KCI) are essential for deep, gaping wounds and Dr. Suzuki calls it a gold standard for most pressure ulcers.
He also uses various types of skin substitutes such as Oasis (Healthpoint), Apligraf (Organogenesis), Dermagraft (Advanced Biohealing), and Alloderm (LifeCell). He says those products are convenient substitutes for split-thickness skin grafting in many of his older patients with poor skin integrity.
A few months ago, Dr. Suzuki started using Qoustic (Arobella Medical), an ultrasound-assisted wound debriding device. He says the product is “much better” than a scalpel for wound debridement.
Increasing rates of obesity can be a concern for wound clinics.
“While we often spend a lot of time focusing on equipment like HBO chambers and debridement devices, we have had to completely reengineer our clinic to accommodate the increasing size and girth of our patients,” notes Dr. Fife. “In the almost 20 years we have been open, we have seen a steady increase in the BMI of our patients.”
Due to the increase of larger patients, her clinic has had to obtain wider waiting room chairs, hydraulic exam tables, a Hoyer lift and a $10,000 electric wheelchair that can move patients weighing up to 800 pounds. Dr. Fife’s wound care facility also has an open “bay” area for examining bed bound patients with pressure sores. She emphasizes that wound centers need to be designed with very large exam rooms and wide hallways in order to accommodate large patients. These patients may transport themselves in their own electronic devices and they often come with family members or caregivers.
Dr. Fife says the most important “equipment” in her clinic is what it uses to document and bill services. Her company, Intellicure, was designed to manage wound center data such as measurements, photos and dressings, as well as calculating the facility and the physician level of service so one is always in compliance with billing rules. This year, she says Intellicure will transmit data to CMS as part of the pay for performance quality reporting initiative.
Q: Which medical specialty do you find essential when it comes to referring patients to ensure optimal care?
A: Dr. Suzuki advocates establishing a good working relationship with local vascular specialists, such as vascular surgeons, interventional cardiologists and interventional radiologists. He says this is “absolutely essential if you are committed to state-of-art wound care.”
Dr. Wu agrees that a good vascular surgeon can improve perfusion for ischemic wounds and treat the underlying venous disease. She often consults with infectious disease specialists and internists for co-management of the patient. Dr. Suzuki says infectious disease doctors have been a great source of collaboration and referrals for his clinics. Dr. Wu concurs.
Dr. Fife’s facility runs a lymphedema clinic and its staff, which is separate from the wound clinic staff, is trained in manual lymphatic drainage techniques and lymphedema bandaging. She says the lymphedema clinic is helpful for patients with secondary lymphedema.
Dr. Fife praises the consulting invasive cardiologists and the endovascular surgeons who do the majority of her facility’s revascularizations. Over a decade ago, she started to recommend endovascular procedures for her wound center patients since the risks of vascular surgery were so high in those patients.