MDNews - Mid Hudson

COVER FEATURE of the wound and the proper referral for definitive treatment. The Faces of Wound Care When the Center for Wound Healing Julie Wagner, R.N., WCC, clinical manager of the Center for Wound Healing, and Jayesh R. Modi, M.D., RVT, FACS, wound care specialist and vascular and general surgeon, Medical Director of the Center for Wound Healing, and Director of the Department of Surgery at Saint Francis Hospital, perform wound care on a patient. From the clinical perspective, even before patients arrive for their appoint- ments, the building of an appropriate care team is under way. The physician and the team perform an initial wound assessment consisting of wound location/ etiology, dimension, depth, exudate, wound base, wound edge, undermining, tunneling, necrotic tissue, epithelial tissue, and signs and symptoms of infec- tion. The assessment eventually leads to a preliminary diagnosis. The discussion then turns to treatment options for the initial visit. A patient with a diabetic foot ulcer, for example, is initially seen by a podiatrist, while a patient with an ulcer on his or her abdomen is evaluated by a medical doctor. Before the patient leaves the Center for Wound Healing, the physician and the team formulate and discuss with the patient and his or her family the con- tinuum of care. This discussion covers wound history, new or confirmed diagno- sis, initial treatment dressings, gauging the patient candidacy for hyperbaric oxygen therapy, negative pressure wound vac, bioengineered skin substitutes or other specialty modalities. If appropriate and time permits, Wagner, for example, introduces the patient to the hyperbaric oxygen chambers and the technician who will be on hand during treatments. Follow-up visits, frequency of dressing 8 | Mid Hudson MD NEWS ■ MDNEWS.COM changes, other diagnostic testing (lab, neurological, neuromuscular and/or vascular workups) and any further questions occur prior to the patient's ending this first visit. Jayesh R. Modi, M.D., RVT, FACS, wound care specialist and vascular and general surgeon, Medical Director of the Center for Wound Healing, and Director of the Department of Surgery at Saint Francis Hospital, and the team of providers at the Center for Wound Healing track patients' progress through patient visits — which typically occur weekly — and administrative monthly meetings, ensuring the multidisciplinary team is in full collaboration to initiate preparations should more aggressive interventions be required. "Our job is similar to that of a detec- tive. We have to find out the cause of the wound and the reason the wound is not healing," says Dr. Modi. "We start with treatment directed at the wound itself and also identify and treat the underlying condition that is causing the wound. We modify the treatment regimen as needed." Dr. Modi adds that although the majority of cases seen at the facility are chronic in nature, the Saint Francis Hospital program triages acute wounds in a streamlined process that allows providers to quickly evaluate the urgency first opened, its staff included nurses, podiatrists and vascular surgeons led by Dr. Modi. Over the years, however, the team at Saint Francis Hospital has expanded to include a wide range of disciplines that allows for coverage of the full spectrum of common and complex wounds. Patients now have access to diabetes counselors, endocrinologists, infectious disease specialists, orthopedic surgeons, physical therapists, prosthetic specialists and registered dietitians. The Center for Wound Healing also works closely and collaboratively with Saint Francis Home Care Services, Inc. "We developed the multidisciplinary approach because these wounds occur due to a variety of comorbidities and, therefore, the center needed to have access to specialists with expertise in various types of conditions," says Dr. Modi. "These providers are all part of the team. Some are permanently present, and others are incorporated into patients' care as needed." That team also encompasses the providers and caregivers in a patient's life beyond the Saint Francis Hospital campus. The referring physician and/ or the patient's primary care physician are considered essential collaborators in the comprehensive approach, as are the patient's family members. Wagner and Francis explain that providers are regularly updated about their patients' wound statuses. "We send out pat ient progress reports to the chain of referring physicians. For example, the primary care physician may refer a patient to the podiatrist, and then the podiatrist refers the patient to the Center for Wound Healing," says Francis. "We send each physician a monthly update throughout the treatment period and then again at discharge. The note includes the plan of care and the patient's progress, with color pictures of progression of the healing wound(s)."

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