Wound Ostomy Nurse Consult Service as an Alternative to the Wound Clinic

Maintaining a multidisciplinary wound clinic is fraught with challenges. When the wound clinic at our large teaching hospital closed, the author proposed establishment of a mobile wound/ostomy nurse consult service to continue to utilize the expertise of our certified wound nurses. Many of our current patients were being referred within our own facility, to ambulatory clinics that were not fully prepared to absorb this workload. Three WOC nurses were already familiar with the patients and could provide a comprehensive introduction to support the new provider along with continuity of care for the patient. Furthermore, the WOC nurses were competent in the billing and compliance issues that envelop ambulatory wound care. Administration was supportive, acknowledging that this would also preserve a portion of the facility’s lost revenue stream. We approached the task of transforming the brick-and-mortar clinic into a mobile service systematically over two months. A critical step was maintaining a reporting log to track volume and referral generation, as a tool to justify our value. Outcomes after one year have been universally positive: Monthly visits increased from 93 to 206. We built new relationships with providers across campus, which we regularly exploit to get patients access to necessary specialty services, of which the primary clinic provider is often unaware. Providers and patients are delighted that they can now obtain same-day wound care expertise. Nurses use the EHR to track patients across campus wherever they have appointments; Closer oversight has lead to better compliance by patients with evidence-based treatment plans, and to discovery of several instances of prescription errors and miscommunication between providers. The service has a positive impact on hospital revenue. In this expanded role, the WOC nurses facilitate communication between provider silos, provide continuity of care, and coordinate the services of multiple specialties thereby increasing satisfaction among all stakeholders.