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Excerpt
PURPOSE: Since the advent of the Prospective Payment System in 2000, old methods of delivering complex wound care have proved to be ineffective in obtaining acceptable outcomes and are no longer cost effective. New methods of delivering advanced wound care have been developed at Florida Hospital Home Care Services (FHHCS) using comprehensive education for nurses and therapists, a wound care team, formulary development, outsourcing, and digital photography to consult WOCN's online, resulting in improved patient outcomes while maintaining cost effectiveness.
OBJECTIVE: The 21st demands that home health agencies meet the challenge of employing new and innovative techniques to optimize outcomes for complex wound patients. The increased complexity of patients in the home and the demands of the prospective payment system necessitate a comprehensive targeted approach. Large home health agencies are no longer able to employ WOCNs as primary nurses for the hundreds of patients they serve. New and innovative modalities for wound healing have been developed. The role of the WOCN has evolved from primary nurse to program manager and educator at FHHCS, a hospital-based agency with an average census of 700–1000 patients.
OUTCOMES: The implementation of advanced wound care delivery at FHHCS has resulted in improved job satisfaction for the clinicians. “ET dependence” has decreased dramatically because of the improved understanding of the fundamentals of wound healing. The clinical focus on rate of healing has increased, largely due to awareness of the events that are expected to occur in acute wound healing and the resultant ability of clinicians to interpret and identify deviations from the norm. This transition has led to a marked decrease in length of stay compared to the national average. Seventy-three percent of the patients at FHHCS come directly from hospitals, an almost 20% increase from the national average; 12% are admitted from nursing homes, representing a 30% increase from the national average; and 63% are admitted with wounds or lesions, a full 23% increase from the national average, yet the average length of stay is a full 30% below the national average of 48 days. Patient's average length of stay is only 33 days. These numbers represent the achievement of the goal of healing wounds within an acceptable time frame while maintaining cost effectiveness.
FINANCIAL ASSISTANCE/DISCLOSURE: Development of educational programs, patient guides, learning resources for clinicians, and digital photography equipment have all been directly supported by FHHCS. No financial support was received for this project.
