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PROVIDING EXCEPTIONAL WOUND HEALING SERVICES NONHEALING WOUNDS ARE a frequent reason for acute-care hospitalization. Wound care physician-surgeon Mikhail Novikov, MD, CWSP, diagnoses and treats patients with a variety of chronic wounds, including pressure sores and diabetic foot ulcers, at facilities across Massachusetts, including the Vibra Healthcare family of hospitals. "As patients recover from acute medical events in the hospital — and nutritional status, blood circulation or heart function improves — we often see good healing of wounds that may have developed during hospitalization, such as pressure ulcers," Dr. Novikov says. "Sometimes, however, these wounds become significant medical issues in their own right. They keep patients in the hospital environment by prompting their transfer to long-term acute care facilities. I assess patients in these facilities and treat them myself or establish the treatment plan and coordinate care with other specialists." Dr. Novikov provides a wide range of treatments to Vibra patients, including minor bedside surgery, debridement, biological skin substitutes, advanced dressings, compres- sion therapy, negative pressure wound therapy and autologous skin grafting. Hyperbaric oxygen therapy is available as an adjunct treatment on an outpatient basis following patient discharge. More than 89 percent of wounds under Dr. Novikov's care heal in 16 weeks, and only 5 percent of his patients require readmission to a hospital. Dr. Novikov and Michelle Doray, Wound Care Coordinator, discuss treatment plans after a procedure. Massachusetts (formerly known as New Bedford Rehabilitation Hospital). A Collaborative Team No element of LTAC ex ists in a vacuum. LTAC patients require complex courses of care involving a wide range of specialists and ancillary providers. The cornerstone of Vibra's centers of clinical excellence is the multidisciplinary team of medical professionals the organiza- tion has assembled and continues to strengthen. At the center of this team are intensivists, hospitalists, nurse practitioners and physician assistants with expertise in LTAC who provide 24-hour coverage at Vibra hospitals and oversee the entire course of patient care. "We are involved in managing pain and underlying comorbid conditions, such as hypertension and diabetes, as well as directing patients' rehabilitation programs," says Joseph Litwak, MD, PhD, hospitalist and Chief Medical Officer at HMS, a staffing and con- sulting organization for hospitalist pr o g r a m s t h a t s up pl ie s h o s pit a l medicine providers for Vibra Hospital of Central Massachusetts. "A comple- ment of specialists from local academic centers and tertiar y care facilities, including UMass Memorial Medical Center and Saint Vincent Hospital, deliver specialty care. "We provide continuity in care — our providers see patients and families on a regular basis and get to know them. T hese prov iders bu ild fa m ilia r it y with patients' cases, and their inti- mate knowledge of patients' courses of treatment ma kes them excellent resources for primary care physicians," Dr. Litwak concludes. The Vibra team of specialists includes cardiologists, an infectious disease specia list a nd a wound ca re/surgi- cal specialist. A pulmonologist with critical care medicine training conducts daily rounds at Vibra hospitals, and a respiratory care specialist is available to provide breathing-related therapy around the clock. One of Vibra's specialties is liberating patients from the ventilator. "Vibra has always been committed to ventilator weaning as a hallmark of care," Dr Litwak says. "For example, Vibra uses a technology that is uncom- mon at other facilities called volumetric capnography [VCO2 monitoring]. Vibra Hospital of Southeastern Massachusetts has been a national leader in the lib- eration of patients from mechanical ventilation using this technology. Vibra Hospital of Southeastern Massachusetts, on average, weans 92 percent of patients in a 14-day period, according to 2014 data. VCO2 monitoring a llows for instant feedback on how a patient is weaning. VCO2 monitoring measures the kinetics of carbon dioxide [CO 2 ] elimination on a breath-by-breath basis. A volumetric capnog ra m conta ins extensive physiological information about metabolic production, circulatory transport and CO 2 elimination within the lungs. VCO2 monitoring is also the best clinical tool to measure dead space, allowing detailed analysis of the functional components of each tidal volume, thereby providing valuable detailed clinical information about the lungs' efficiency of gas exchange. If a patient is having trouble weaning, VCO2 monitoring lets the clinicians know in real time whether the difficulty is due to a pulmonary or a cardiovascular issue." "Vibra has a strong rehabilitation division staffed by physical, occupa- tional and speech therapists," Dr. Bagley says. "Provision of an intensive rehab program is central to achieving our goal of helping patients regain maximum functional independence. Our nurses are equally essential to patient care — they are skilled in managing individuals PHOTOGRAPHER: RYAN RICHARDSON M D N E W S . CO M ■ MD NEWS Greater Boston | 7