Cath Lab Digest

  Over the years we have seen many sad illustrations of what happens when patients don’t have proper wound dressings. We have all seen patients arrive with dressings made from paper towels, cleaning rags, saran wrap or underwear. Sadly, in some cases, the problem was not that patients lacked insurance coverage for dressing supplies, but that no caregiver had told them of this benefit. Patients followed for months by clinicians who ought to have known better (eg, excellent surgeons) are stunned and then angry when they discover that they have needlessly paid large sums of money “out of pocket” for dressings. Patients can lose faith in the clinical skills of a practitioner who is uninformed about issues like dressing coverage policy! So, the first thing clinicians need to know is that most patients who have medical insurance have some sort of DME coverage for dressings.

  In 2007, TWC published an issue on Before the patient can be seen, the clinic has to determine how it will prepare a bill (charges) for the services rendered to the patient. This means that every hospital clinic needs to develop a chargemaster that is specific to their department in order to capture charges and ensure consistent billing. The layout of individual facility chargemasters varies from hospital to hospital; however, it includes a core group of data elements that correspond to all of the services, procedures and supplies that may be used in that facility.

It is a well-accepted fact that compression therapy is considered the standard of care for patients with chronic venous insufficiency (CVI). In the absence of significant lower extremity arterial disease, the use of different types of compression wraps and garments are often the single most effective component of CVI treatment. The external pressure of the compression wrap on the underlying venous system assists the calf muscle pump in the return of blood to the heart and lungs from the lower extremities, decreasing the venous hypertension that is the causative factor in many lower extremity ulcerations. Observing the effect of compression on patients with ulcers related to CVI can be an incredibly rewarding experience for the clinician because when appropriately applied, edema reduction is rapid and ulcer improvement is sure to follow. However, we are often faced with patients who are unable to maintain these wraps and dressings for the time period that they are supposed to be worn. It is a frequent occurrence to have patients return to the clinic with their compression wrap out of place or worse, having taken it off at home. Regardless of advanced dressing options and alternative treatments, CVI therapy without adequate compression usually results in further ulcer breakdown.

The Challenges of Negative Pressure Wound Therapy in Clinical Practice

This article is a joint effort by Dot and Caroline, bringing together perspectives from our combined (too many to confess) years of practice. We have brought our slightly different but complementary viewpoints together on the clinical challenges of Negative Pressure Wound Therapy (NPWT).

It doesn’t seem like it’s been nearly 20 years since a pharmacologically-based company called Curative began working with hospitals to create outpatient wound care centers and expanded to manage nearly 200 such centers across the country.