Integrating Inpatient Care to Your Outpatient Wound Care Center: Key to Successful Patient Management

Abstract

A smooth integration between inpatient admissions and outpatient care is essential for a positive outcome in limb salvage. In fact, Wukich and colleagues propose that one of the three objectives of an inpatient diabetic foot service should be to optimize the transition from inpatient to outpatient care (Wukich et al., Diabetes Care. 2013,36(9),2862–71). This is no easy task. Patients requiring acute care hospital admission for limb salvage undergo multiple procedures over several days, or, in complex cases, several weeks. It is not unusual for these patients to require multiple admissions in a given year. During each admission comorbidities are managed by a revolving team of providers from numerous services and subspecialties. When patients are discharged their limb salvage journey is by no means over. Timely and coordinated outpatient follow-up must be arranged and details of each hospitalization must be made available to those individuals who will be providing continued care. Unfortunately in the USA, over 19% of discharged patients experience an adverse event such as an emergency department visit or readmission within 3 weeks of discharge (Brockaway, https://hub.tmlt.org/tmlt-blog/coordinating-care-between-inpatient-and-primary-care-physicians, 2013). Additionally 20% of Medicare patients are readmitted within 30 days of discharge from acute care hospitals (Sheikh et al., Jt Comm J Qual Patient Saf. 2018;44(5):270). To address the challenge of this critical transition period, Medstar Georgetown University Hospital’s (MGUH’s) limb salvage service utilizes a team of nurse practitioners (NPs) which, interfacing closely with the outpatient clinic, seeks to minimize readmissions, reduce adverse events in the immediate period after discharge, and most importantly, maximize the potential for successful limb salvage.