HCA  Retreat  Doctors’  Hospital  and  Chippenham  Johnston-­‐Willis  Medical  Center,  Richmond,  VA:  Community-­‐Based  Specialists  Wound  Healing  

Center  ProgramsJoseph  V.  Boykin,  Jr.,  MD,  FACS

Medical  DirectorAssociate  Clinical  Professor,  Plastic  Surgery

Virginia  Commonwealth  University,  Medical  College  of  VirginiaRichmond,  VA

HCA Retreat Doctors’ Hospital and Chippenham Johnston-Willis Medical Center, Richmond, VA: Community-Based Specialists Wound Healing

Center Programs

The HCA Wound Healing Centers at Retreat Doctors’ Hospital and Chippenham Medical Center, Richmond, VA are a hospital-based service staffed by teams of community based medical and surgical specialists.

Outpatient clinics of both facilities operate on a full-time basis. Initially organized at the Retreat Campus in 1997,

WHC operations expanded in 2010 to include a comprehensive wound care facility at Chippenham

Medical Center.

Boykin 2001

WOUND PREVENTION AND

EDUCATION PROGRAMS

GRANT FUNDED WOUND HEALING RESEARCH AND DEVELOPMENT

HYPERBARIC OXYGEN (HBO)

THERAPYBURN PROGRAM

WOUND AND SKIN CARE EVALUATIONS AND TREATMENTS

WOUND HEALING

CLINIC (WHC)

VENOUS STASIS ULCER THERAPIES

& LYMPHEDEMA

SURGICAL CONSULTATIONS AND TREATMENT

DIABETIC ULCER EVALUATIONS AND

DIABETES LIFESTYLE CENTER

WOUND HEALING MANAGEMENT

CENTER OFEXCELLENCE

HCA/Retreat and Chippenham Wound Healing Centers

Retreat Doctors’ Hospital is a campus of Henrico Doctors’ Hospital, named one of America’s 50 best hospitals by HealthGrades four years in a row.

227 Bed Acute Care Hospital in Richmond, VA Home to the nationally recognized Wound Healing Center (Established 1997)

and the only Complex Care Program of its kind in the region.

Chippenham and Johnston-Willis Hospitals make up CJW Medical Center, Richmond, VA - HCA Virginia Health System.

466 Bed Acute Care; Level 3 Trauma Center Home to the Wound Healing Center (Established 2010) and Diabetes

Lifestyle Center

HCA / Retreat and Chippenham Wound Healing Centers

Wound Healing Center OrganizationMedical Director: Plastic Surgeon

Plastic Surgeons – 6Vascular/General Surgeon – 1

Medical Specialist – 1Physician Assistant - 1Nurse Practitioner – 1

Research Nurses (RN) - 2Clinical Director: RN

** Clinical Nurses (3-CWCN’s): RN / LPN - 20**Certified HBO Staff: RN / LPN – 3

Case Manager (RN) - 2Administrative Office Staff - 4

** cross training requirements for FTE staffingClinical hours (scheduled): Monday-Friday 40 hours/wk

On Call Staff Available for HBO Emergencies 24/7

WHC CLINICAL OBJECTIVESDIAGNOSIS

Focused, Multidisciplinary Evaluation of Chronic Non-Healing Wounds or Ulcers Related to Illness,

Disease or TraumaTREATMENT

Prioritization and Implementation of Medical and Surgical Therapies for Wound Healing or Resolution

MAINTENANCEOrganization of Ongoing Patient Education,

Follow-Up and Referral Network to Minimize Frequency of Recurrence

Accessibility of up-to-date wound evaluations for MDs working within HCA network

WHC GOALS

Efficient Utilization of Available Resources to Enable Wound Healing / Problem Resolution

Minimize In-Patient Wound Care and Enhance Proficiency of Outpatient/Home Health Care Providers

Development of a Network of Providers for Problem Wound Evaluation and Management

Pros

WHC Development: Community Based specialists

Consideration for Participation

Improve Office Flow for Wound Patient Consultations

Create a Staff of Wound Care Specialists and Technicians Who Support Your Practice

Reduce Office Overhead for Wound Patient Care

Improved Wound “Outcomes”

Increased Time Commitment and Responsibility for Wound Patient Care

Decreased Reimbursement for Consults and Procedures

Perceived as Only a “Wound” Surgeon

Must Become Versed in “Multiple” Technologies of Wound Care

Cons

• Corporate vendor:design not tailored to needs of community

• Minimal start-up costs• Clinical leadership may

be ”imported” for start up• Revenues substantially

lower and “shared”• Continuity not guaranteed

Comparative Operational Structures for Community Based Center

Turn-Key Operation

WHC Development

Local Development

• Design based on needs of community and pro forma: add/delete technologyas needed

• Considerable start-up costs• Identify clinical leadership

from community• Revenues remain in center• Local incentives for staff

continuity

Strategic Implementation Plan *Critical Factors*

WHC Development

Wound Healing Center Leadership– Medical Director / Clinical Director -

Medical and Nursing Staff commitment (Long Term Growth)

Sharing WHC Development with Medical/Surgical Specialty Peers in Community

Streamlining Medical / Surgical Referrals for Wound Management

Organization Not Based on a Single Wound Technology (e.g., HBO)

Define the Limitations of Care for Center Operations

WHC DEVELOPMENT

ADVANCED WOUND CARE TECHNOLOGIES

HYPERBARIC OXYGEN THERAPY TISSUE-ENGINEERED HUMAN SKIN EQUIVALENTS RECOMBINANT GROWTH FACTOR TECHNOLOGY NANOCRYSTALLINE SILVER TOPICAL BACTERIAL WOUND

TREATMENTS NEGATIVE PRESSURE WOUND THERAPY ULTRASONIC WOUND DEBRIDEMENT

WHC OPERATIONS (RDH) 2009New Patients – 742F/U Patients – 2435

HBO Treatments – 1600

HCA RETREAT/CHIPPENHAN WHC CLINICAL RESEARCH PROGRAMS

Participation in Over 30 Clinical Research Studies

– Industry Sponsored– Investigator Initiated – Single Center– Multi -Center– International

Personnel Include

– Principal Investigator– Sub-Investigators– Director– Certified Clinical Research Coordinator– Research Nurses

HCA RETREAT/CHIPPENHAN WHC CLINICAL RESEARCH PROGRAMS

• Types of Studies: National/ International

– Phases One Through Four– Inpatient and Outpatient– Major Industry Sponsors and Bio-Tech Companies– Drug and Device – Pharmacokinetic– Bio-Marker Evaluations

• Indications

– Diabetic Ulcers – Vascular Ulcers– Hyperbaric Oxygen Therapy– Nitric Oxide and Homocysteine – Pressure Ulcers – Diabetes Management– Diabetic Gastroparesis– Painful Diabetic Peripheral Neuropathy

Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy is administered at both campuses using four (4) Sechrist monoplace chambers (two chambers at each campus) that are modified for ventilator applications for

critically ill patients requiring life support. WHC MDs and staff are on call 24 hrs for evaluation and treatment of emergencies

requiring HBO therapy.

The Department of Hyperbaric Medicine (Retreat Doctors’ Hospital) received Accreditation through the Undersea & Hyperbaric Medical Society Clinical Hyperbaric Facility Accreditation Program – Level

One / With Distinction 13 March 2009.

Boykin 2001

Boykin 2001

Boykin 2001

HBO Therapy DX Groups*

Non Healing Wounds 65%

Osteomyelitis5%

Osteoradionecrosis 15%

Others (CO, Infections,Decompression)

15%

(*) average group %

Wound (Ulcer) Type

HCA Retreat Hospital and Chippenham Medical Center

Wound Healing Center

Diabetic Ulcer (Foot) Venous Stasis Ulcers Pressure Ulcers (All)

Vascular (Ischemic) Ulcers ORN, STRN, Trauma, Surgical, etc.

30%15%30%12%13%

~% Wounds Treated

Clinical Outcomes – (Review)

Boykin 2001

HCA Retreat Doctors’ Hospital and Chippenham Johnston-Willis Medical Center, Richmond, VA: Community-Based Specialists Wound Healing

Center Programs

Diabetic Limb Salvage / Diabetic Foot Protocol 2010

Implementation of the Wound Healing Center Programs has provided an efficient referral and treatment conduit for patients

presenting with diabetic limbs at risk.

A Diabetic Foot Ulcer Protocol has been developed through the coordinated efforts of both centers developed by a multidisciplinary

team using six sigma problem resolution to identify disconnects during routine referrals. With this protocol all diabetic patients with lower extremity wounds entering our facilities are quickly identified for consultation within 24 hours with Vascular, Surgical, Wound and Radiology services with admission orders established for treatment.