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Achieving Collaborative Clinical & Operational Workflows in the Outpatient Wound Clinic

Wound care clinics continue to operate under multidisciplinary models. Implementing effective workflows is essential to producing optimal outcomes.   

Associated morbidity, decreased quality of life, and, in extreme cases, mortality   are among the many reasons significant interest continues to be given to best practices for the prevention and treatment of chronic wounds. For those healthcare providers and specialists who manage this patient population, a multifaceted approach to care, through which the integration of clinical practice guidelines and a wound care-specific electronic health record (EHR) with “smart” clinical and operational workflows, is required. 

Determining the proper clinical and operational skill sets among staff members is necessary to manage the chronic wound care patient and is a key component to maintaining smart workflows. Operational practices for the wound clinic include establishing effective processes for patient registration as well as appropriate coding and billing. Cognitive workflow by clinicians will vary based on one’s discipline, such as nursing and physical therapy. In seeking to achieve collaborative workflow between clinical and clerical staff, it is important to define goals such as:

  • determining roles, responsibilities, and skill sets;
  • knowing documentation requirements for place of service and scope of practice;
  • supporting evidence-based care guidelines;
  • understanding national and local coverage determination policies;
  • developing policies and procedures to ensure compliance;
  • reducing duplication of efforts and documentation;
  • determining procedures to be completed by job roles;
  • developing order sets and templates;
  • employing patient safety, quality, and risk initiatives;
  • supporting continuity of care across the continuum; and
  • developing an audit plan.

All wound care clinicians possess an understanding of chronic wound healing principles based on their discipline, education, and scope of practice.

However, the skill sets and modalities necessary to care for the wound care patient may be different in healing the patient with a chronic wound. The following sample crosswalk supports the workflow for collaborative care in the wound care hospital outpatient department (HOPD). Designing collaborative clinical and operational workflows requires review and customization of current clinical and documentation practices for an efficient outcome. Current practices include the operational processes for registration, coding, and billing as well as the cognitive workflow by clinicians. Producing the right mix of operational oversight and clinical experience, grounded with a wound care-specific EHR imparting smart workflows, will yield effective efficient clinical and operational practices.


Cathy Thomas Hess is chief clinical officer and vice president at Net Health, Pittsburgh, PA

Cathy Thomas Hess, BSN, RN, CWOCN
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