A Novel Approach Utilizing a Triage System for Patients Needing Reconstructive Plastic Surgery at a Large Urban Wound Center

Background: This Wound Center receives approximately 100 monthly referrals for reconstructive plastics. In addition to the typical plastic reconstructive requests, this center also accepts cranial defects, abdominal defects, auto immune, hypercoagulopathies, radiation and breast reconstructions, GYN and other cancer repair requirements.  Patients were waiting 2-3 months for an initial appointment to be realized. Often the wound was far from ideal for a positive surgical outcome, and the patient was ill-prepared medically to undergo surgery. Preparation for surgery is lengthy and patients that typically take 2-3 months. Follow up with surgeon to be placed on the OR schedule added another 4-6 weeks before the initial surgical intervention.

Methods: The concerns and ideas were taken to physician counsel. It was agreed that all plastics outpatient referrals would be screened by the practice manager and referred to one of 3 clinic MDs that are family practice or internal medicine wound specialists. Reconstructive procedure pathways were developed for each planned surgery. Every patient is reviewed at start of care with the plastics physician during weekly case rounds and a potential surgery date is established. 
This population now receives an appointment with the Wound Center within days of referral. The “whole” patient is examined and the RN partner coordinates all needed diagnostics, services, and coordination of care. At times the patient may not need a plastics procedure and healing can be accomplished through evidence based care and advanced products.

Conclusions: This system has relieved the schedules of the plastic surgeons to allow patients needing surgical interventions to be scheduled more quickly. If a surgical procedure is required for best practice, it is scheduled near the start of care, allowing all necessary preop requirements to be completed and authorizations obtained. The patient has a resolved end point months earlier than the traditional path with less morbidity and mortality.