New Wound Care Center Serves a Remote Area
October 31, 2007 | Leave a Comment
Hyperbaric and Wound Care Center at Davis Hospital
LAYTON, UTAH
The Northern Utah area was totally underserved for specialized wound care and hyperbaric oxygen therapy until the Hyperbaric and Wound Care Center at Davis Hospital opened in April 2007.An outpatient service of the largest hospital in the county, the wound center is located in a new office building next to the hospital Emergency Room. Davis Hospital is owned by Iasis HealthCare.
Centrifugal Debridement Using Advanced Surgical Technology
October 31, 2007 | Leave a Comment
Modern literature on debridement initially centered on the life-saving benefits of debriding wounds sustained during war. The impact of debridement on decreasing war wound-related mortality was so profound that a century ago the concept of radical debridement became a dogmatic imprint on surgical mentality that has only recently been challenged.1,2
How Much Do YOU Know About Debridement?
October 31, 2007 | Leave a Comment
Study the examples of wounds, debridement action taken, practitioner delivering care, and tissue removed. Assume the care facility is a hospital-owned outpatient wound department (HOPD). Then determine the type of debridement, documentation, and coding.
Understand that in actual practice, you would have a great deal more information about the patient in your care — eg, medications, nutritional status, previous treatment, and vascular status.Also, the information given may not match the exact history of the patients in the pictures; it was compiled to illustrate particular scenarios.
Discuss these cases with your clinical group.Then, please share your answers with TWC.Take a few moments to email your responses to our Editor at twc@hmpcommunications.com.
The Debridement Dilemma
October 31, 2007 | Leave a Comment
CAROLINE E. FIFE, MD
A chance to cut is a chance to cure.— Medical proverb
Non-viable (necrotic) material within a chronic wound has been shown to inhibit the development of vascular tissue (granulation) and the formation of skin (epithelialization). Devitalized material enhances bacterial growth while at the same time decreasing resistance to infection. The removal of such material is called debridement.
WHAT YOU CAN EXPECT FROM YOUR MANAGEMENT COMPANY
October 31, 2007 | Leave a Comment
PAT HUDSON, RN, BSN, CWCN;
SHERRILL A. WHITE; TERRY;
BEARD, RN, RRT, CHT, ACHRN
From conception to recognition as centers of excellence, wound care clinics must make education a priority. Management companies understand the importance of a knowledgeable team and have spent years refining and perfecting the education process. Not all managed companies are alike — hospital and wound clinic decision makers must understand what type of knowledge and support will be provided by the management company before partnering with them. Ultimately, the hospital should seek an accredited, comprehensive approach to education that includes all staff involved in the care and support of a wound center patient.The instruction provided should address key areas of clinic operation: wound care and hyperbaric medicine, clinical practice guidelines, advanced wound management, program operations, clinical coordination, safety, database outcomes management, quality improvement and accountability, reimbursement, patient education, marketing, and community education. The following article details what a hospital should expect from a management company in terms of education support of its wound clinic.
Staff Education: Independent versus Managed Facility
October 31, 2007 | Leave a Comment
Education is a never-ending process of acquiring knowledge and skills and developing powers of reason and judgment. In an independent wound clinic, educational responsibilities are handled in-house. The following discussion offers insights into the way one independent wound clinic, the Archbold Center for Wound Management, Thomasville, Ga, addresses staff educational and training needs.
Background. Our wound care program consists of an outpatient clinic where patients are seen both for MD appointments as well as regularly scheduled wound care.We also consult on acute care patients with complex wounds and provide any advanced wound care required during the hospitalization. Additionally, we oversee the wound management practices and round on complex cases at our four affiliate hospitals and four nursing homes.
Debridement Reminders Issued by OIG and Payors
October 31, 2007 | Leave a Comment
Keeping Abreast of Recent Developments
KATHLEEN D. SCHAUM, MS
The Office of Inspector General (OIG) Work Plans for the past few years include a study to determine the extent to which Medical Part B surgical debridement services met Medicare program requirements. The findings from the May 2007 OIG Report, Medicare Payments for Surgical Debridement Services in 2004 (available at: http//:oig.hhs.gov/oei/reports/oei/02-05-00390.pdf) offer several important insights.
In 2004, 64% of surgical debridement services did not meet Medicare program requirements, resulting in approximately $64 million in improper payments. Of these, 39% were miscoded, 29% had insufficient documentation, and 1% were deemed medically unnecessary (overlapping errors = 5%). In addition, most carriers had local coverage determinations (LCDs) and edits in place but conducted limited medical review of surgical debridement services.
CUTTING THROUGH THE CONFUSION
October 31, 2007 | Leave a Comment
The TWC Editorial Board labored over how to address the important, controversial, and confusing topic of debridement. An integral part of the day-to-day care provided in hospital-owned outpatient wound care departments (HOPDs), debridement removes devitalized tissue from a wound that otherwise would be slower to heal, at higher risk for infection, and not receptive to more advanced topical treatments such as wound matrix technology, negative pressure wound therapy, growth factors, and bioengineered tissues.
Radiation Enteritis in the Patient with a Fecal Ostomy
October 10, 2007 | Comments Off
Your patient presents with a history of ovarian carcinoma, 2 years post pelvic exenteration, chemotherapy, and pelvic radiation therapy. She has a colostomy and an ileal conduit. She now is experiencing extremely high output from her colostomy, symptoms of dehydration, frequent leakage and skin irritation, and a short wear time of 24 to 48 hours for her colostomy pouching system. After her physician and ostomy clinician make a thorough assessment, the diagnosis is radiation enteritis.
