Measure for (Quality) Measure

  I have the honor of being a member in one of the longest running Shakespearian Clubs in the United States. Every Tuesday evening during the frigid North Pennsylvania winter, ladies in gowns and men in tuxedos meet at the downtown Woman’s Club to read, act, and study the Bard. The tradition has continued for nearly 130 years. This past year I played Ford in the Merry Wives of Windsor. I am partial to the comedies, in particular Shakespeare’s mastery of dramatic irony.

  Which brings me to the AMA’s Physician Consortium for Performance Improvement® (PCPI™). It has proposed to CMS two new quality measures for wound care that do not really do much to improve quality. But they would fit nicely into a Shakespearian comedy:

Act One. “All the World’s a Wound Clinic.”

  Sir John Falstaff and his nurse Bardolf enter the wound clinic stage right

Bardolf: A messenger from the King awaits without, m’lord.

Falstaff: He is most welcome, Nurse Baldolf. He is come with the latest measures of quality for the care of wounds. This surely bodes well for my purse. Show him in.

Enter Sir Pompous Peppermill
(stage left)

Falstaff: Well met, Sirrah. Well met, indeed. Some sac, mayhap?

Sir Pompous: Never on duty, Sir John. I have an urgent message on behalf of the King. Henceforth, and from now on and forever, two quality measures for wound care will be followed and adhered to: Thou must immediately quit the swabbing of wounds and cease and desist using wet-to-dry dressings in your clinic. If followed steadfastly, these measures are quality measures that will assure quality in your clinic and coin in your pocket. Henceforth, you will be rewarded for the number of times you do NOT do the shameful things.

Falstaff: Most excellent suggestions, Sir Pompous.

Sir Pompous: These are not suggestions or proposals or propositions or ideas or plans! They are Quality measures, Sirrah. Measures that you will institute and begin and start posthaste immeditely.
(Exit stage right)

Nurse Bardolf: Methinks Sir Peppermill doth overspeak, Sir John.

Falstaff: Have a care Nurse Bardolf. Speak well of the King … and of his messengers. Now get you to the closet and confect a batch of miracle goo—go light on the sugar and heavy on the betadine. And, bring me a quill pen so that I can prepare the list of the things NOT DONE for which I will be rewarded by the King.

Act Two. “What Wound Doth Heal But by Degree?”

  Darkened stage. Candles slowly brighten to reveal that great cathedral of bloat, Sir John Falstaff –his first soliloquy.

Debride or not Debride
That is the question.
Whether ‘tis nobler in the clinic to take arms against a sea of wounds
And by opposing, end them?
Or to follow the edict of his majesty’s lackeys and perpetuate the myth of
healing with a meaningless palliative—and cheap––measures.
Fie! Fie on’t. ‘Tis a slough of regulations. An unweeded garden that grows to seed.
That we but teach bloody instructions, which, being taught, return to plague the inventor:
Gold! Aye, there’s the rub. His majesty makes my purse and my belly grows great whilist my goodly nurse Bardolf labours elbow deep in the pus and putrefaction of our state-run hovel ‘ministering nostrums of sugar-water and betadine.
Do I take a stand ‘gainst the state?
And watch my purse evaporate?
Or do I do as others do and sell my honour for a mess of pottage?
All this cogitation has swelled my thirst
Bardolf—more sac. Quickly, man.

  Unfortunately, at this point our comedy turns tragic. There is no closing act for Falstaff to get what is coming to him. He continues his profitable practice. It is clear that the wound care world is not well served by the currently proposed negative quality measures. As I have noted in previous articles the wound care field needs measures that will truly improve quality. The Alliance of Wound care Stakeholders has taken up the challenge of addressing quality measures on wound healing. I suggest that everyone with an interest in promoting and preserving our specialty get involved.

Dr. Thomas E. Serena, MD, FACS, MAPWCA, FACHM, is the founder and CEO of the Serena Group™ family of companies operating wound and hyperbaric centers across the United States, providing point-of-care services for nursing facilities, managing inpatient wound care teams, and consulting for more than two dozen industry partners worldwide. Dr. Serena is the medical director for New Bridge Medical Research, a not-for-profit company dedicated to advancing the science of wound healing. In this capacity, he has conducted more than 50 clinical trials, published over 100 scientific papers, and given more 250 invited lectures across the globe. He is the vice president of the American College of Hyperbaric Medicine, sits on the board of the Association for the Advancement of Wound Care, and is a former board member of the Wound Healing Society. Currently, he serves as chairman of the AAWC Global Volunteers. He has taught wound care and conducted research in Rwanda, Cambodia, and Haiti.