Make operations manual a wound clinic priority

Methods of care must be documented

One of the most common mistakes new wound care clinics make is one of omission. Clinic planners and managers often don’t put together an operations manual containing tried and tested policies and procedures for running the clinic, according to Gerit Mulder, DPM, MS, president of Denver-based consulting service Wound Sciences Inc. Mulder has managed a wound care center and has assisted in opening dozens of others.

He says he often sees new clinics with operational policies that are woefully inadequate to handle the contingencies of daily operations. The manual should be a resource that staff members can consult to determine how to treat specific wound types, how to assess wounds, how to chart information, which referral agencies to deal with, and countless other details of wound clinic operations. All forms used by the clinic should be included in the manual as well.

"You need standardized procedures of some sort and you need to develop and document consistent methods of care," Mulder says. "Without them, you won’t be able to treat patients properly. Yet most new centers don’t have them."

Creating operational guidelines requires bringing together all the professionals who will ultimately be involved in the clinic. "It does take time," Mulder says. "You have to sit down and decide for every type of wound and problem what basic procedure everyone should follow."

That’s not to say procedural guidelines preclude exceptions to the rule; not all wounds can be treated "by the book." Rather, the guidelines establish a central path that all staff can follow, thus increasing the likelihood that the level of care will be consistent regardless of the clinical situation and the clinician.

Protocols, algorithms, and critical pathways are the basis for the clinical side of any wound care clinic, according to Jan Cuzzell, RN, MA, CNS, vice president of THA services, a home care management company in Savannah, GA. She compares them to road maps that assure consistency of care and outcome evaluation. Dozens of such protocols have been published in wound care literature, and new ones appear regularly.

There’s also the matter of establishing procedures for the more mundane but equally important clinic management activities, according to Cuzzell. She says an experienced office manager can provide valuable insight into how to develop appropriate forms and figure out efficient processes for managing activities such as patient referrals, organizing account records, and setting up computer billing and collection systems.

Show proof of efficacy to managed care payers

The policies and procedures also should spell out methods for monitoring, recording, and communicating outcomes to payers. Managed care demands proof of efficacy, and that proof can only be demonstrated through meticulous patient assessment and record keeping. Establish such procedures before the clinic opens its doors.

An operations manual also should identify staffing needs and specify job descriptions and responsibilities of various staff.

Once the policies and procedures have been established, the next step is to set up standards for continued quality improvement, says Mulder. "You need to give your staff competency exams to make sure everyone is up to the right level of education and that they know the procedures. Do this at the start, and then periodically to make sure quality is maintained."