![[ Visit WOCN Website ]](images/banner.jpg)
Purpose: Lower extremity amputation rates at a large teaching hospital in the South East Region have been consistently above average, particularly among African Americans. Our large tertiary health system has made a commitment of redesigning care for this patient population. A coordinated multidisciplinary team approach to care will reduce time to follow up wound clinic appointment, hospital length of stay (LOS), readmission rates, and numbers of patients requiring multiple amputations.
Objective: A multidisciplinary steering committee was formed; including representatives from hospital medicine, podiatry/orthopedic surgery, certified wound care nurse (CWCN), vascular surgery, and anesthesiology. Using a combination of related ICD-10, MS DRG, and CPT codes, we defined our target population as patients 18 years old or older with a non-traumatic lower extremity wound (including vascular, neuropathic, and diabetic ulcers as well as ulcers with underlying osteomyelitis) admitted to the hospital over the course of one calendar year. After review of baseline data for our patient population, separate work groups developed (1) a standardized work flow and order set for emergency department (ED) providers; (2) an admission order set for admitting providers; (3) a multidisciplinary rounding team; (4) a surgical team to more efficiently take the patient to surgical debridement; (5) a pre-and post-operative order set for patients undergoing surgical debridement or amputation; (6) regional blocks to provide better pain relief with multimodal analgesia when appropriate and (7) enhanced education materials for patients with wound care needs at discharge and those undergoing amputations.
Outcomes: Multidisciplinary care can provide more efficient and effective care for patients with lower extremity wounds or amputations through the use of standardized consult criteria, inpatient and pre/post-operative order sets, involvement of anesthesia for regional blocks and education materials.
Objective: A multidisciplinary steering committee was formed; including representatives from hospital medicine, podiatry/orthopedic surgery, certified wound care nurse (CWCN), vascular surgery, and anesthesiology. Using a combination of related ICD-10, MS DRG, and CPT codes, we defined our target population as patients 18 years old or older with a non-traumatic lower extremity wound (including vascular, neuropathic, and diabetic ulcers as well as ulcers with underlying osteomyelitis) admitted to the hospital over the course of one calendar year. After review of baseline data for our patient population, separate work groups developed (1) a standardized work flow and order set for emergency department (ED) providers; (2) an admission order set for admitting providers; (3) a multidisciplinary rounding team; (4) a surgical team to more efficiently take the patient to surgical debridement; (5) a pre-and post-operative order set for patients undergoing surgical debridement or amputation; (6) regional blocks to provide better pain relief with multimodal analgesia when appropriate and (7) enhanced education materials for patients with wound care needs at discharge and those undergoing amputations.
Outcomes: Multidisciplinary care can provide more efficient and effective care for patients with lower extremity wounds or amputations through the use of standardized consult criteria, inpatient and pre/post-operative order sets, involvement of anesthesia for regional blocks and education materials.