The Multidisciplinary Wound Care Team

We launched this publication in spring 2007. The first issue provided readers with articles discussing the “tools” needed to build a successful wound clinic and featured imagery of a construction worker complete with a tool belt on the cover. Initially, I thought “this a bit of an odd look for a healthcare journal,” but the concept grew on me as we put that issue together and I realized that each specialty discipline represented by those of us on the editorial board provided a different skill set and unique “tool box” with which we built our own clinics. Just as with building a house, which requires a construction crew including the influence of a framer, a plumber, an electrician, an architect, and a designer to ensure a sound, functional structure, any successful wound clinic needs a staff of physicians, nurses, podiatrists, physical therapists, lymphedema specialists, coders, and documentation experts (as well as many others) to not only heal chronic wounds but to care for the underlying etiology and to help patients improve overall function and quality of life. We are currently in a rapidly changing healthcare environment and all providers are adjusting to these changes in order to prove their worth in a more competitive market. Quality care is now the mantra for all healthcare organizations. Quality metrics and benchmarks now establish the template for caregivers across the continuum. The focus for us now is on value versus volume. In a sense, we all must rebuild (or at the very least re-evaluate) our wound clinics and how we go about providing care. To do so, we must look at our wound care teams to make sure they’re properly staffed to handle the demands of a new healthcare climate. That’s what this issue of Today’s Wound Clinic (TWC) is about. 

The Multidisciplinary Team

Providing patient care within the new healthcare system will require us to be more efficient clinically while maintaining financial awareness for our clinics (as well as hospitals in some cases). As we move toward inclusion in accountable care organizations and bundled-payment initiatives, we must determine how the outpatient wound clinic fits into a larger patient care experience. We have to treat more than simply the wound until closure and address more effectively the underlying etiology and subsequent impact on the patient’s life.  With this issue of TWC, we look more specifically at some of the unique skill sets inherent among the various disciplines of healthcare professionals working in wound clinics who are needed to improve the overall patient care experience and clinical outcomes. For several years, the diverse membership of the outpatient wound care team has diminished as the result of regulatory changes and evolving reimbursement issues. Many of these changes are in response to overuse of certain treatments and lack of appropriate documentation on actual need or, frankly, inappropriate billing. Physical therapy- and nursing-driven clinics have given way to physician-driven clinics with referral to outside services in a more fragmented fee-for-service model. As more healthcare systems move toward a more seamless model, collaborative efforts under the same roof are beginning to re-emerge. A system that focuses on overall quality care and efficiency of what is provided will be rewarded. By matching patient need with the skills of each discipline, we will more effectively care for the patient as a whole. I’m not the only physical therapist who cringes each time she/he sees a patient who’s living with a diabetic foot ulcer receive appropriate debridement, excellent foot care, and an offloading device, but leave the clinic without an evaluation of his or her gait pattern so that the need for an assistive device can at least be explored. Witnessed recurrence of a healed wound on a patient living with primary lymphedema because the patient wasn’t referred to a decongestive therapy specialist early in the wound healing process is also beyond concerning. By recognizing one another’s strengths across the spectrum of healthcare clinical roles, we can all change the wound healing model to one of complete patient care while maintaining our own professional autonomy.