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Starting a Wound Center

Monday June 12, 2000
Lisa Hill, RN
Lisa Hill, RN
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With the aging population and millions of people afflicted with acute and chronic wounds, it's no wonder that wound centers are emerging to meet the needs of patients and care providers. Wound centers expand care delivery, manage wound care costs, provide complete physical assessment, and offer medical/surgical management, self-management skills, state-of-the-art treatment, and timely follow-up. As a clinical nurse specialist, I recently had the opportunity to assist in the development of The Comprehensive Wound Healing Center® at Abington Memorial Hospital.
Wound centers may enhance the quality and value of care provided to our patients, but how do we determine if a wound center should be started? The first step is performing a review of the literature and an analysis of the community for current wound centers and their strengths and weaknesses. Although the data collection may not increase your intuitive knowledge, it is necessary to support the wound center business plan for those who may not be as familiar with your industry. This information will guide you in developing a market analysis.
The second step is completing a needs assessment, or market analysis, of the area you service. It's critical to gather demographic data relating to gender, age, and typical admitting and discharge diagnoses. It's also important to gather information such as-
· the number of admissions and discharges with specific ICD-9 diagnoses that relate to wound patients (707.0, 682.9, etc.)
· the prevalence of wound-related CPT codes for admissions and discharges and wound-related ICD-9s
· the incidence of pressure ulcers for patients who have been discharged to home
· the breakdown of third-party payers for all diagnoses served, as well as for specific wound-related ICD-9s
If possible, it is helpful to collect 10 years of data and compare it for an expanded service area. Staff in the health services department at my hospital helped me to gather data and make projections for the future. Compiling and extrapolating the data will show if there is a significant potential wound population and/or possibilities to increase vascular or plastic surgeries in your area.
Once the review of the literature and market analysis are analyzed and show a high-volume wound population, it becomes necessary to develop a business plan and appeal for professional and financial support. The plan should include a mission, scope of practice, facility overview, hours of operation, staffing, financial implications, executive summary, and a strength, weakness, opportunity, and threat (SWOT) analysis. Within a hospital setting, it is helpful to work with the finance department to validate your financial impact, not only with regard to office visits and procedures provided, but with referrals to other hospital departments.
Although the business plan is crucial, it's important to have professional support to help market the concept. Collaborating with other disciplines (physicians, nurses, dieticians, physical therapists, and occupational therapists) will validate the need for the center and encourage a multidisciplinary approach to patient outcomes. Generating support during the business plan development may be time-consuming, but it will be energy well spent once the plan is approved and the center is open. As nurses, we often don't view ourselves as "sales people" despite the fact we "sell" the successful steps to recovery to our patients everyday. I was amazed at how my nursing skills helped me in this process.
Developing the unit's policies, procedures, and documentation tools is the next step. When developing tools, it's important to account for JCAHO and AHCPR standards and staff habits with documenting, patient flow, and format ease. This will help to ensure compliance and quality care. Because nurses, respiratory therapists, plastic surgeons, vascular surgeons, general surgeons, and internal medicine physicians staff our center, I developed tools that are compatible for everyone.
The final step is selecting product inventory and developing supply standards. In light of the anticipated ambulatory PPS changes, this will be a crucial step in controlling your cost-per-visit ratio and ultimately affect your revenue-generating potential.
Although developing a comprehensive wound healing center can be tough, the benefits far outweigh the challenges. At The Comprehensive Wound Healing Center®? we treat patients holistically by addressing underlying problems, educating for prevention and treatment, and collaborating with primary care physicians and home care nurses. The Center is ensuring continuity of care for inpatients and outpatients with wounds and ostomies, is ensuring accurate wound diagnosis and comprehensive wound management, is decreasing the median rate of healing for wound patients, and is reducing the severity and prevalence of lower extremity amputations. For questions or further information about Abington's Comprehensive Wound Healing Center®, please call (215) 481-4325.