A few years ago, someone close to our team had the unfortunate experience of a surgical site infection (SSI). We’ve read about SSIs, reported data on them, educated on how to avoid them, and were beyond devastated to experience it firsthand. They share their experience in the spirit of helping providers to exceed patient expectations for future care.
This patient had a 3 x 5-inch hole in their body that was ripe with pseudomonas when they arrived at the wound center. The incision should have fully closed weeks prior. It would be a 3 1/2 month journey that included countless oral antibiotics, topical antibiotics, IV antibiotics, an allergic reaction, a PICC line (very scary as the actual patient), 2 wound care centers, 1 infusion center, 4 wound care doctors, consults with several other doctors, too many wound vacs to count (SNAP vac is super cool though), 40 dives in the hyperbaric chamber, a lot of tears, a ton of stress, and an incredibly supportive tribe of family and friends. It’s a happy ending though. The wound healed and we know a lot more about patient experience in wound care.
Check out these tips direct from the patient (in their words) for exceeding patient expectations in wound care:
“It’s like the tale of two cities, but instead it is the tale of two wound care centers. While there were positives to both centers, the best illustration of how to exceed patient expectations in wound care is to simply share the experience at both centers.
Don’t assume insurance is a barrier.
Wound Center A delayed my care several times waiting on insurance approval, despite me telling them I would simply pay cash if that would speed it up or if it wasn’t approved. I’m lucky that I can do that. But, would you believe that they actually told me they wouldn’t even know what to charge me as the cash rate for a wound vac or a dive in the hyperbaric chamber? Even to make an appointment, they wouldn’t put me in as cash pay. They insisted on waiting to find out about my insurance benefits delaying my care a day. In all honestly, I don’t think they heard me. Like really heard me. They heard the words I said, but didn’t consider that I might know what I was talking about.
The takeaway here: If a patient wants to give you money to remove the insurance barrier, take it. And, then help them bill insurance if they want. Don’t exploit a patient’s willingness to pay. But, if they are emphatic about getting the right care right now regardless of cost, give it to them.
Assume time is of the essence.
In my observation, most of the patients in Would Center A were going to be long term patients. Like, really long term. There were a lot of amputees, repeat patients, and the majority of my fellow patients no longer worked or were no longer able to work. The pace at Wound Center A functioned as such. Dives were under limited hours and wound care appointments regularly ran late. As someone who was working through treatment, it was maddening. And, even if I wasn’t working, it still would have been maddening. I was fortunate to be able to drive myself. Many of the patients had people taking off work to drive them. I was literally in a hurry to get better, but there was no sense of urgency there.
Conversely, at Wound Center B, I didn’t get to know my fellow patients as well because I wasn’t sitting around waiting. But, I did 7 am dives regularly with several people that had to get to work. They even offered one late night a week. And, my appointments always ran on time. They staffed well enough that even on unplanned consults with the physician, there was very little wait time. The center ran like a well-oiled machine.
The takeaway: Assume that every patient’s time is valuable and that curing them as efficiently and effectively as possible is paramount.
Know your schedule.
Appointments were moved frequently by Wound Center A because the physician wasn’t going to be there or they were closed for some other reason. I would also “hear” from a patient or staff in a different area that they would be closed on certain days. So, I would then have to chase down the answers and reschedule my appointments. This was hard for me since I work. It also delayed my care a few times. I ultimately ended up diving elsewhere when they were closed. Patients will be forgiving to schedule changes, but it should be the exception, not the rule.
Takeaway: Stick to your schedule and let patients know way ahead of time of changes. If you do have to be closed during normal business days, have a backup for patients.
Be prepared. Anticipate needs.
I had a SNAP vac, so it worked a little differently than a traditional vac. I can’t tell you how many times I’d have an appointment on a Thursday and knowing that my vac would be full by Saturday, but Wound Center A wasn’t prepared to change it. Or, I would be scheduled for hyperbaric oxygen (HBO) therapy and they wouldn’t have anyone prepared to remove the vac. They would scramble because that vac can’t go in the chamber. It was as if the next step was always a surprise to them. I’m no wound care clinic administrator, but if it were me, I’d make a chart of anticipated milestones and schedule around those. As the patient, I also never knew what the plan was. Give the plan to the patient. The plan may change, but this will also help manage their expectations and minimize calls to the clinic.
The takeaway: Keep track of when your patients should need a dressing change, wound vac change, HBO, etc, and plan for it. Schedule their appointments to efficiently care for them. Anticipate their needs.
Manage your inventory.
Back to those vac changes. I’d be there for an appointment and ready for a SNAP vac change, but they wouldn’t have any in inventory. There’s definitely a range, but it’s only a day or so. Again, it was as if it was a shock to Wound Center A every time it was due to be changed. And, the same goes for supplies. There were multiple times that Wound Center A didn’t have the supplies (like a skin substitute or specific dressing) that the doctor wanted to utilize. I had good insurance and cash. Within reason, they should have been able to get anything that I needed. There were a few times that the doctor personally supplied special dressings because the center didn’t have them.
The takeaway: Communicate with your providers, look at your upcoming schedule, and anticipate your inventory needs based on this data. If you can’t manage it dynamically or have too many delays, work with your providers and nursing staff to establish baseline inventory that you’ll always have on hand.
Communicate with each other.
I observed the best and worst of this between the two wound care centers.
At Wound Center A, many of the players on the team were great. The hyperbaric nurse was awesome!! The doctor was a big thinker and very talented. The wound care nurse was knowledgeable and caring. But, no one was driving the processes. There was a lack of proactive communication between the team members. So many things fell through the cracks because they didn’t communicate with each other. And many times, the hyperbaric nurse went out of her way to get things back on track that the rest of the team should have taken care of prior to diving. I constantly had to tell them what other team members (office manager, benefits, doctor, etc) had said or planned. Blame and defensiveness were common.
Conversely, at Wound Center B, everyone was on the same page and regularly communicated. They used time outs, checklists, and clearly had strong processes and protocols. They also pivoted well when things didn’t go according to plan. Because they had good processes, things didn’t fall apart when they had to add on a patient or change a plan. And, they did a lot of their verbal recaps in person in front of me which helped keep my expectations in line.
Takeaway: Create strong communication between team members with solid processes. Create a culture based around great patient outcomes and teamwork, not blame and defensiveness.
Select antibiotics that are effective for the specific infection.
I’m no doctor, but here’s me stepping out of my scope and giving medical advice (insert extreme sarcasm). I understand the concept of empirically treating infections. I do. But, when someone has a wound that isn’t healing properly, can we all just agree that proper antibiotic selection is vital? Twice, antibiotic selection delayed my treatment.
At each post-op appointment from my original surgery (two surgical sites), I complained of more pain on the one side. At the third post-op visit, the surgeon prescribed a broad-spectrum antibiotic, but didn’t culture the wound or say that it was infected. There was no nefarious behavior here. In fact, I think it was quite the opposite. I think the surgeon was just adding an antibiotic to be on the safe side. Spoiler alert: the bacteria that caused my infection (Pseudomonas) wasn’t sensitive to that antibiotic. A week later, it was so bad that I got a wound vac. It doesn’t matter now, but a proper culture at that third post-op visit could have prevented this entire blog post.
Several months in, I was getting weary and down about the hole in my body not healing. Wound Center A went for a more aggressive approach – a PICC line with IV antibiotics. I wanted the infection gone, but was nervous. So, I had a loved one (that happens to be a nurse, do wound care, and be a former pharmacy tech) be part of the conversation.
The doctor explained everything and was planning to use an antibiotic that she had really good success with. After the conversation, my loved one looked up the antibiotic. Pseudomonas isn’t sensitive to it. After sharing this with the doctor, they agreed that it was not the right antibiotic. The doctor then selected one specific to Pseudomonas and the results of the culture. Again, no ill will here. This doctor was just trying to do everything in their power to heal me. In the midst of that, they just failed to double-check that it would be effective.
Takeaways: For serious stuff, culture it and only prescribe antibiotics that the bacteria is sensitive to. Or, start an antibiotic and once the culture comes back, change it if necessary. Clearly, document all of this, especially the thought process. Second, have a tribe that looks out for you.
Have a good mechanism for managing patient communications.
Patients will put up with a lot if they believe in their provider. I put up with treatment delays, treatment errors, lack of planning, and more. But, the final straw with Wound Center A was the lack of a good mechanism for patient communications.
On day 1 at Wound Center A, the doctor told me to email her if I needed something. She said not to call the center. She said she checks her email at least once a day and that it is the best way to reach her. I’ll spare you the details, but had a reaction to an infusion and emailed the doctor as she had instructed, then called Wound Center A, plus the infusion center called after they saw me. It took 75 hours to get a response from the doctor. The doctor was out of town at a conference and there was a weekend in there. I didn’t have 75 hours to wait. I never went back to Wound Center A.
Oh, and the doctor (who I genuinely do like) offered empathy when they responded via both email and voicemail. But blamed me in both. Apparently, I was to call a certain phone number that was never given to me. I know the “blame” was just covering the bases for litigation, but it added insult to literal injury.
Two takeaways here:
1. Have a clear mechanism for patient communications. It’s on you to be sure your patients know how to reach you. Educate them on it in multiple different ways – handout at the first visit, email on what to expect, on your website, and verbally at the first visit. Document it too.
2. There are times in healthcare that it is appropriate to apologize. It’s well documented that a genuine apology actually reduces litigation. So, apologize properly when needed. And, be sure to tell the patient what you are doing to ensure it does not happen in the future.
Have a good mechanism for managing communications with other providers.
Again, I won’t bore you with the details, but the infusion center in the situation was put in a bad position. I woke up to the discovery that I had a reaction to the initial dose, the prescribing doctor was out of town, they couldn’t reach the prescribing doctor, and the prescribing doctor didn’t have a backup physician or standing orders for a reaction.
Takeaway: Have a plan and a backup plan for patients that go to an infusion center. And, let them know how to reach you or who to call in your absence.
Be unashamedly frugal.
At Wound Center B, I got a bag and a locker. In it, I kept some personal items to use after HBO, my Vashe (taped over each time and placed in a sealed bag), and my topical antibiotic. They educated me on why they did this.
Takeaway: Keeping costs low is cool. Educate patients and make them part of the process of reducing expenses.
Talk about what the patient can do for healing.
The doctor at Wound Center A was very up on functional medicine, supplements, and how diet and exercise affect our health. They did an awesome job educating me and my tribe about foods, supplements, and hydration for healing. I debated taking a scheduled vacation because of my wound and they said that I needed it to heal. They also had a contagious positivity.
I’ve actually kept up several things they taught me, like the value of collagen. Whether you are into non-traditional treatments or not is up to you, but we can all agree that proper nutrition, exercise (if acceptable), and an overall healthy lifestyle set us up for good healing. Also, it gave me something that I could control. I had zero power over that hole in my body, but I could make sure I ate anti-inflammatory foods, followed a mostly whole-food plant-based diet, and drank my collagen twice a day. It made me feel good to be part of the solution.
Takeaway: Talk to your patients about how nutrition and lifestyle impact their wound healing.”