No Man is an Island—Without His iPhone

  I have reached the highest frequent-flyer level on US Airways in record time this year. In fact, George Clooney played me in the movie “Up in the Air.” In the past, I would strike up conversations to assuage my boredom. Today, although waiting times are significantly longer, I have far fewer interactions with my fellow travelers. The reason is “I-isolation.” Toddlers to seniors concentrate on iPhones, iPads, and a myriad of other devices. My father used to say, “Look them in the eye when you meet someone.” However, eye contact is now restricted to “i-contact.” Truth be told, I must be included in this group—a premium member. Perhaps we need an “I-interact-with-those-around-me app?”

  However, this phenomenon is not exclusive to airports. Recently, I was invited to sit on a panel at a meeting on pressure ulcer prevention and treatment. The audience was comprised primarily of nurses working in acute and long-term care. As the only physician in the room, it was left to me to defend my specialty. I did not fare well. One inpatient nurse asked: “If the present-on-admission documentation must be performed by a physician, where am I supposed to find one with experience or interest in wound care?” I replied, “The outpatient wound care center, obviously.” The room broke into uproarious laughter. I asked for a quick show of hands: do physicians working in your outpatient wound center perform inpatient consultation? Not a single hand went up. At times like these, I realize that I owe a great deal of my wound education to my nursing colleagues.

  Unfortunately, isolation has been part of the standard operating procedure for many of the outpatient wound and hyperbaric centers in the United States. They labor in some sequestered corner of the hospital with little or no interaction with the inpatient staff. A number of forces, mostly monetary, have led to this wound care chasm. First of all, there are simply not enough “woundologists” (a physician who focuses on wound care full-time). This has improved somewhat as the economics of wound care has improved: multidisciplinary wound and hyperbaric centers allow clinicians to see patients with complicated wounds without incurring the expense of dressings and advanced wound care products, and physicians are able to bill for hyperbaric oversight while simultaneously working in the wound care center.

  The commonly employed physician staffing model, allotting each physician a four-hour block of time, has also contributed to outpatient seclusion. A physician panel comprised of up to ten part-time practitioners does lend itself to expansion to inpatient services. As more full-time woundologists staff the centers, there will be an increased opportunity to provide inpatient consultation.

  The solution to this wound care segregation is likely to come from an unexpected source, the Accountable Care Organization (ACO). Those in the know are not entirely sure if ACOs will come to fruition or if they do, exactly how they will operate. What is clear is that in order to function in the ACO, services will have to be delivered across all patient care settings. Outpatient isolation will no longer be an option.

  In preparation for inevitable change, outpatient wound care centers should consider expanding to the inpatient side. When choosing a management company, hospitals should inquire about provisions for inpatient services.

Dr. Thomas E. Serena, MD, FACS, MAPWCA, FACHM, is the founder and CEO of the Serena Group™ family of companies operating wound and hyperbaric centers across the United States, providing point-of-care services for nursing facilities, managing inpatient wound care teams, and consulting for more than two dozen industry partners worldwide. Dr. Serena is the medical director for New Bridge Medical Research, a not-for-profit company dedicated to advancing the science of wound healing. In this capacity, he has conducted more than 50 clinical trials, published over 100 scientific papers, and given more 250 invited lectures across the globe. He is the vice president of the American College of Hyperbaric Medicine, sits on the board of the Association for the Advancement of Wound Care, and is a former board member of the Wound Healing Society. Currently, he serves as chairman of the AAWC Global Volunteers. He has taught wound care and conducted research in Rwanda, Cambodia, and Haiti.