Observations from a Wound Healing Clinic

Dr. Christopher Attinger’s wound healing clinic at Georgetown University Hospital, with its complex case-mix, aggressive treatment approach, and support service infrastructure (technology and people), may be one of the most advanced wound healing environments in the world. Having been absent from the complexities of the direct patient care environment for some time, I found myself immediately saturated with dozens of managerial observations.

By 9:30 am, the clinic was in full-swing. I walked through the clinic’s waiting room counting approximately ten patients. Sitting next to each patient was at least a single caregiver; at a first assuming blush these caregivers were family members or nurses, this assumption would be later confirmed. The waiting room was near capacity, the smells permeating the clinic’s air were that of mild hospital soap mixed with ‘wound’—a smell reminding me of peeling a bandage or gauze from still healing flesh. While sitting in the waiting room, I noticed patients with prosthetic limbs, crutches, walkers, and wheel chairs, respectively. I found myself thinking about what each of these patients had to endure on their way to the clinic: the complexities of getting dressed, of waiting for or securing transportation to the clinic, and then the obvious stairways, access ramps, and elevators which had to be navigated on the way to the clinic.

While walking to the first exam room, Dr. Attinger provided a high-level scope of the clinic’s operations: 1,200 patients per year, six exam rooms, two operating rooms, four hyperbaric chambers, an electronic medical record interface, and diabetics comprised 60% of the case mix. From a patient care perspective, I was immediately struck by Dr. Attinger’s approach: noticeably quick, professional, and courteous. During the patient visit, Dr. Attinger asked the patient a series of questions, voiced his concerns or lauded praise with respect to healing progress, and took his notes within the electronic medical record system in real-time. Due to the nature of chronic wound healing (60% of chronic wounds never heal), Dr. Attinger carried a meaningful rapport with most, if not all, patients seen that day.

His staff primarily comprised of: residents, nurse practitioners, nurses, and a podiatrist, were well-tuned to the clinic’s pace. After leaving one exam room, it was immediately on to the next. From my vantage point, the clinic operated like an engine cruising at an efficient 65mph until lunch-time. As a multi-disciplinary wound healing operation, the clinic was even staffed daily with a readily available prosthetic specialist. The prosthetician was able to quickly suggest changes to/for custom prosthetics which would allow wounds to better heal. The prosthetician service alone created a continuum of care uncommon to many clinics, be they wound or otherwise.

Aside from normal clinic operations, I noticed several patient opportunities for improvement, which may take place at healthcare’s most strategic levels.

1. For example, several patients mentioned the complexities involved with navigating homes and/or jobs which seemed to be non-compliant with the Americans with Disabilities Act (ADA). This made me wonder who advocates on their behalf, what resources, be they legal or otherwise do they have at their finger-tips which could assist in making buildings more ADA compliant?

2. I also noticed the need for patient education resources. Patients (or their caregivers) with wound healing challenges should have a relatively high-level of working healthcare knowledge: i.e. they must know their medications, the kind and types of dressings used, etc. Patient education resources in wound healing should be developed for both patients and caregiver audiences and should be minimally bilingual for Spanish.

3. Wound healing education must extend beyond patients and caregivers and must also consistently include primary care doctors and nurses. It has been noted that some primary care doctors recommend a hydrogen peroxide regimen for chronic wound healing patients—this is false information.

4. There may also be an opportunity to discuss and decide what makes a wound healing clinic a wound healing clinic; i.e. the development of consistent wound healing clinic practices and services. At the very least, patients (or their caregivers) should have a basic understanding of what separates one wound healing clinic from another wound healing clinic.

As the combined projected increases in diabetic and elderly patients manifest, the societal burden of wounds must be seriously considered. Chronic wounds affect not only the patient, but their caregivers, and given the fact that 60% of chronic wounds never heal, scalable prevention measures must be taken into account as well.

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