From The Editor

He was one of those patients who reminds you of why we’ve dedicated our careers to wound care. Kevin was from the beautiful, historic city of Natchitoches, LA. It was seven years ago when his good friends had driven him nearly five hours to Houston Medical Center to see me for a pressure ulcer because there was no facility capable of managing his condition near home. Seeing Kevin was a treat for me. He was a woodsman and a naturalist, and there was nothing about hunting and the habitat of Northern Louisiana he didn’t know. His paralysis had not slowed him down. The only animal he had given up hunting from his wheelchair was wild boar. We’ve kept in contact ever since. Eventually, he and his friends were to take my son on his first dove hunt when we visited him in Natchitoches. Coincidentally, I had been invited by local wound care clinician Frank Aviles Jr., PT, CWS, WCC, FACCWS, CLT, wound care service line director at Natchitoches Regional Medical Center (NRMC), to participate in one of the regularly occurring Wound Healing Roundtable events he hosts at Natchitoches Events Center for local clinicians and industry representatives. Thanks to Frank’s determination to recruit and educate wound care clinicians in Natchitoches, patients like Kevin who are living with chronic wounds are finding it easier to seek care near home, along the banks of the Cane River, as opposed to traveling great distances. Frank’s most recent roundtable had an impressive turnout despite his having to compete with several social events within the small town that evening. As part of the event, he interviewed me, Kevin, and another remarkable patient whose leg had recently been saved thanks to timely intervention by physicians at the Natchitoches center. Frank guided the conversation with a series of questions that engaged roundtable participants and guests. It was a fantastic educational event and a wonderful evening for me as a wound care provider. Frank’s passion for wound care and his vision for bettering his local community’s delivery of care enticed me to share some of his ideas and success stories through an interview that’s offered here. I hope you’ll find Frank and his work as intriguing as I do!

Caroline Fife (CF): Please explain your roundtable events:

Frank Aviles Jr. (FA): The Wound Healing Roundtable event is a gathering of clinicians, industry partners, and community members to promote evidence-based care and to learn the science behind available products in a dynamic and didactic session. The mission is multifaceted and includes interactive participation in an effort to provide education to people working in areas with limited resources, improve communication across the continuum of care, develop a true collaborative network of clinicians, and improve the delivery of care to our patients to achieve desirable outcomes. The message for each roundtable is simple, yet the delivery is quite powerful. A topic for discussion and members of a multidisciplinary panel are selected to discuss a particular topic. We discuss a related case study and foster thought-provoking conversations surrounding the topic. The caveat is participants get to witness the interaction between multiple disciplines, which gives an accurate representation of what it’s like working together in a fashion that allows people to use their individual skills and talents to achieve a common goal. To end the evening, the “guest of honor” — the patient whose case study was selected — will share his/her story, which is typically one of successful limb salvage. The patient’s message is heard loud and clear. 

CF: Who’s invited, and how many people typically attend?

FA: Anyone who’s interested in wound care, with the notion of “leave no one behind.” Roundtable attendees have included physicians, administrators, industry partners, allied staff, corporate leaders, key opinion leaders, and selected patients. This past year, students, patients, and community members were added to the list of invitees. When the informal roundtables were relocated to local restaurants in 2010, we had an average of 50 attendees. Last year we averaged 120 participants per event. We have physicians and clinicians who’ve traveled as much as two hours each way to attend. Industry partner attendees have come from all over the country.

CF: Are educational credits offered?

FA: To this point, no, but it is a goal to achieve for the future. 

CF: When did you start the roundtable events, and what was the impetus?

FA: It really was something that grew out of a sense of frustration. More than 20 years ago, I had experienced the best on-the-job wound care training I could ask for by a phenomenal instructor, Joyce Rohan, PT, at a teaching hospital’s outpatient-based physical therapy wound program. She inspired me to continuously keep up with current evidence-based practices to help our patients living with wounds, but most importantly to focus on the entire patient. In 2005, shortly after moving to this area, I quickly realized a lack of resources for our wound care providers and patients. My frustration began when I noticed failed patient outcomes, with the common denominator being a lack of appropriate education and limited resources. To this day, I still remember moonlighting with patients located 135 miles away (one way) who were essentially identical in their conditions but largely different in their outcomes because of their treatments. Some were able to leave the hospital with both feet intact while others back in Natchitoches had amputations and decreased life expectancy. I wanted to take an active role in changing this problem. So, this became a bit of a personal quest and determination to help patients receive evidence-based care across the continuum at the right location, at the right time, with the right outcomes. 

CF: How would you compare your first roundtable with where you are today?

FA: The first event was held at a small hospital and the format was quite different, but interest from clinicians and attendance kept growing. In 2009, we increased the size of the room and provided educational in-services covering many topics for 14 consecutive weeks. These topics were selected in order to set a foundation. In 2010, with continual growth, the meetings were moved to local restaurants with ample space. In 2012, we moved to the local event center, where we started needing just one room and have since grown the event to fill three rooms.

The more roundtables we host, the easier they are to coordinate. Years ago, it would take at least six months to plan, coordinate, and successfully execute one event. Now, with experience and more contacts, it takes little time to plan.

CF: What kind of support do you get from the hospital, vendors, and your staff?

FA: Initially, this was truly a one-man show. As I captured the attention of providers and grew interest, vendors wanted to be involved. Where else can clinicians and industry stand on the same side of the fence with the same goal in mind? Vendors are able to reach many rural agencies in one sitting instead of three weeks of traveling to meet them individually. Now, I did set strict “ground rules” for the vendors up front to ensure an unbiased environment while keeping the patient as our focus. While clinicians are learning the science about various products in order to use them appropriately, they’re avoiding product failure associated with escalating costs. I am thankful for every vendor that has participated in every roundtable we’ve hosted in/out of Natchitoches.

One year ago, we opened a new, state-of-the-art wound care center —NRMC Comprehensive Wound Care Services. We have an incredible, talented, and devoted staff that volunteers time to assist me with the events. Additionally, I am also so thankful for Jamie Fontana, program director of our wound care clinic. Together, working endless hours, we are making a huge impact in the quality of care being delivered to our community. Our CEO has also been instrumental in allowing me to continue my passion while following our hospital mission to inspire excellence throughout the hospital system and our community.

CF: Why does your region need these roundtable events?

FA: We have known for years that rural healthcare providers face many challenges. Rural areas do not typically have access to specialists, we have to work longer hours due to less support staff, the pay is decreased compared to our urban counterparts, products and other resources are typically limited, caregiver assistance is more limited, and educational opportunities are fewer. I wanted to make a difference for our patients in this community. In 2008, I was encouraged by an administrator at Louisiana Extended Care Hospital - Natchitoches to help educate other providers and to “spread the wound care word” across the continuum. This administrative support allowed me to start educating through my newly developed consulting company, since this area did not have an outpatient wound center at the time. My motto was, if patients can’t travel to a local wound center (as it was nonexistent), then I would travel to them. This effort increased local awareness, education, resources, communication, and coordination of services to improve outcomes. I saw opportunities when others classified local clinicians as wound care “competitors” — as vendors trying to peddle products. I saw networking opportunities and the chance to assist our patients and viewed vendors not as a “car salesman” or product peddlers but as education extenders. I’d soon learn there were talented clinicians in our region who were practicing in a silo. It was an ah-ha moment for me. My mentor and longtime friend, Dot Weir, RN, CWON, CWS, was one who empowered me to make a difference in my local community. My vision was to save limbs through education for clinicians at every level and becoming the “air-traffic controller” or “the hub” for our patients until attaining my dream of having my own “airport” — an outpatient wound center.  

CF: How would you describe Natchitoches to those who’ve never been?

FA: Many people can’t pronounce Natchitoches (Nack-a-tish), let alone know where we are. Natchitoches was made famous by the various plantation homes, including Oakland Plantation, hosting the annual Christmas Festival of Lights, and the movie Steel Magnolias, which was filmed here in 1989. It is a beautiful town and a perfect place to raise a family. The city is 22.63 square miles with a population of 18,323.  Community members often have to travel to nearby larger cities located close to two hours away to reach airports, shopping malls, and larger hospital institutions.

CF: How do you inform people of upcoming roundtables?

FA: This has been challenging. When I started the event, I did so without sponsorships, a budget, any assistance, or allotted time despite a hectic schedule. But you learn to become resourceful.  After each roundtable, I’d be responsible for any expenses incurred that weren’t covered by donations. That said, I personally marketed the roundtables by sending invitations by fax, email, and asking clinicians/facilities to spread the word. Each subsequent roundtable increased my clinician database, making the invite process easier. Now we have other means to notify our community, such as social media, radio and newspaper advertising, live radio shows, and even full coverage of roundtables on the radio for those unable to attend.

CF: How often do you host the roundtables?

FA: Twice annually. Due to the overwhelming positive feedback we’ve been receiving, we are now offering them at other locations, as requested. In the meantime, specific educational training is provided to clinicians, facilities, students, and our industry partners.  

CF: Why choose the roundtable approach rather than inviting a speaker for a more traditional event?

FA: People have different ways of learning and absorbing information. We have all attended lectures where the instructor either speaks over the audience’s head, presents basic information, or delivers information not relevant to our practice. I want to optimize every educational opportunity. Being able to deliver critical wound care information that greatly impacts patient care through various panel speakers provides a testament as well as a powerful message. Imagine seeing pictures of a horrible lower extremity wound case study that healed as clinicians resourcefully used their skills and expertise to save their limb. Then, the actual patient shares his/her own perspective about the care they received. Along with multiple panel members from various disciplines sharing information in various ways, I’ve found this helps the audience to remain engaged. Also, a difference of opinions is welcomed and often encouraged between speakers, as this is the reality that we face daily. My job is to bring forth evidence-based practice/studies to educate participants to handle these situations. With this format, we’re fostering an interactive, multidisciplinary presentation where people can actually learn, utilize, and implement valuable clinical information relevant to their daily practice.  

CF: What’s your goal for future roundtables, and what’s the next step?

FA: My expectation is to continue making a positive impact on the quality of care currently being provided to patients across the continuum. Concurrently, I’m trying to break down barriers in an effort to have successful outcomes by providing educational opportunities to more clinicians. In my opinion, when a passionate individual creates an environment that fosters education, mentorship, communication, individual growth, networking, outcomes, and accountability, clinicians will support these types of clinical endeavors to optimally improve patient care. The next step, as initially planned, is to provide continuing education credits for wound care clinicians while continuing to partner with industry to provide this educational opportunity to other locations. 

Caroline E. Fife, MD, FAAFP, CWS, FUHM, is chief medical officer at Intellicure Inc.; executive director of US Wound Registry; medical director of St. Luke’s Wound Clinic, The Woodlands, TX; and co-chair of the Alliance of Wound Care Stakeholders.