The September issue of Wounds contains a supplement called, “Management of Chronic WouWounds: Diagnosis, Preparation, Treatment and Follow-up,” supported by Acelity. It’s an amazingly comprehensive compendium of information and is available in its entirety online here:
Periodically I’ve been posting cases from my clinic that I call “Don’t miss this.” Nearly all of them are patients I’ve inherited from other wound centers that missed the opportunity to make the right diagnosis or “do the right thing.” Honestly, I think I’ve made every mistake that you can make in this field, some of them more than once, so I am not finger pointing EXCEPT for the fact that protocols exist for a reason. If you follow protocols for arterial screening or performing biopsies, then you are not very likely to miss arterial disease or skin cancer. That’s the reason pilots have checklists even though they have flow the plane thousands of times, which was the inspiration for Atul Gawande’s book, The Checklist Manifesto.
The Wounds supplement is fantastic! But, it makes you realize how nearly impossible it is to raise practice standards with a paper document. We won’t drive quality of care forward for patients with wounds by creating even better guidelines or writing even more pathways. We will do it by delivering clinical practice suggestions at the point if care inside the electronic health record (EHR), linked to evidence based quality measures. Practitioners need clinical suggestions that are relevant to the specific patient they are seeing, and they need them as they are seeing the patient. EHRs can do that, but they HAVEN’T been, because our standards for our EHRs have been too low.
The other thing to realize about clinical pathways is that although we depict them on a piece of paper as if they were a flat decision tree, they are iterative. Offloading, for example, is something that you tackle again and again every week, perhaps transitioning through various options until the patient “graduates” to custom insoles.
Some of the material in the September Wounds supplement will be presented with a slightly different emphasis at an Acelity sponsored dinner session during the up-coming Fall SAWC in Las Vegas called, “Mind, Body, Wound – A Consensus on Holistic Care,” on Saturday October 21, 2017 from 6:30 pm to 8:00PM.
I hope I will see you there where we can continue the conversation.
And thanks for the great comments about fantasy healing rates!
My Fall SAWC 2017 Schedule
Friday, October 20
Debating New Pressure Ulcer/Injury Staging
The National Pressure Ulcer Advisory Panel (NPUAP) held a consensus conference in April 2016 to discuss and revise the current pressure ulcer staging system. This session will debate the need for a staging system and discuss whether the use of a linear staging model truly helps clinicians and patients, or does it make them vulnerable in the hands of prosecutors?
Saturday, October 21
Industry-Supported Dinner Symposia (Non-Accredited/Non-Approved for CECH): Mind, Body, Wound – A Consensus on Holistic Care
Sunday, October 22
Clinical Applications for Hyperbaric Oxygen Therapy: Identifying Appropriate Patient Selection for Successful Outcomes