Cath Lab Digest

After a seemingly interminable amount of time, your wound center is open. You are seeing patients and helping them with their chronic wounds. Everything is going well.
Or is it? How is the wound center really doing? Are you practicing thorough, efficient, efficacious, cost-effective, evidence-based wound care? Are your patients doing well — ie, healing and/or comfortable? Are they happy with the way care is provided? Are you making any money (a distasteful but realistic question)? How do you know (ie, is any of this documented)? These difficult questions must be answered if you are to provide patients the best care available in a fiscally responsible manner.
Our hospital-based wound center has been in operation for 10 years. We have found that periodic consideration of these questions is a must. Not only do we discover if our therapies are working for our patients, but we also learn whether our patients are pleased with the services we are providing and if we are fiscally sound.

Measuring Success
At our center, we have three considerations relevant to ensuring our wound care program is operating successfully. The first is to determine whether we are providing evidence-based wound care and, if so, whether our outcomes are comparable to local and national standards and results in the literature. The second is to evaluate how our patients perceive our provision of care. The third, and probably the least important to us as clinicians but most important to administrators, is to ascertain if we are we financially healthy.

Is care evidence-based? Determining whether you are practicing evidence-based care is fairly easy. Most wound centers treat patients based on protocols or algorithms. If current wound care practices in your center follow evidence-based protocols, you should be providing good patient care. However, while protocols may offer direction and consistency, not all patients respond the same way to identical treatments. Douglas Hyde, CEO of OshKosh, once said, “There is only one way to do something and that is the right way.” The right way for each of our patients is the way that works best for them as individuals within the parameters of the protocols. Rigidly adhering to only one therapy may not result in successful outcomes for all patients, even those with similar problems.

How you assess how patients are responding to treatment depends on how your center tracks patients. If you have an electronic medical record (ECM), outcomes data are available at the touch of a button on your computer. If a computer database of some type is not available, chart review will be necessary. Healing rates, complication rates (such as infection), amputation rates, and other data should be evaluated for each major wound type treated in the center. Once collected, the information should be compared to national standards and randomized, controlled clinical trial results for the particular wound type being treated.

If your center’s outcomes are comparable to published data, pat yourselves on the back — then try to better your figures. If your center’s outcomes do not quite measure up, do not presume you are treating the worst patients on the planet. Use this as an opportunity to evaluate your treatment regimens and techniques and improve outcomes. Perhaps more recently published algorithms should be considered and protocol changes made. If you are unsure how to proceed, contact someone you consider an expert in wound care and seek his/her advice. Most everyone with whom I have worked would be happy to provide assistance to you and your center.

Are people satisfied? The second consideration is satisfaction levels at the wound center. This may be the most critical area to evaluate. Three factors should be addressed:
1) satisfaction of the staff working in the center,
2) satisfaction of the patients receiving the care, and
3) satisfaction of the referring physicians. Each is equally important and must meet high standards if the wound center is to function successfully.

Staff satisfaction. Satisfaction of the staff working in the center is crucial to your success. If the staff are not happy in their jobs caring for patients with wounds, the entire care process can be slowed or stalled. The provision of efficient wound care depends on each staff member knowing his/her task and being willing and eager to perform it. Disgruntled or envious employees compromise the wound center atmosphere.
In our wound center, we see between 60 and 80 patients per day. How well the staff work together is a factor in the care of our patients. I am familiar with wound centers where certain staff members perform specific tasks — if someone is unavailable to do the task, the rhythm of operations is disrupted or ceases while everyone waits until the job is done. This does not make for a happy staff or happy patients and certainly does not portend an efficient operation. Everyone in the center must be dedicated to making the wound center operate smoothly. For any operation to work efficiently, every staff member must be committed to doing whatever it takes to make the organization function.