Northern California`s Mecca of Wound Care

O'Conner Hospital's Wound Care Clinic

In 1990, O’Connor Hospital in San Jose, Calif, was aware of the need for a wound care clinic. As a result, O’Connor Hospital’s Wound Care Clinic (WCC) was developed into a modern day Mecca for wound care in Northern California.

According to the current Medical Director, Peter Schubart, MD, PhD, it began when the hospital agreed to sign a contract with Curative Health Services (Nashua, NH) allowing the clinic to open its doors in 1992.

One patient was seen on the first day. Currently, the clinic averages 35–55 patients a day and offers 13,000 sq ft of space and 20 treatment rooms, with approximately 7,000 visits and 600 new patients per year.

The original clinical staff consisted of Dr. Schubart, vascular surgeon; Dr. Bruce Lerman, podiatry; and Dr. Jude Roussere, general surgeon. All of these physicians currently remain with the clinic. The facility currently employees 24 people including, two of the first RN staff.

TWC asked Schubart to fill in some of the details of the center’s operations.

TWC: Can you describe the types of employees that work at the clinic?
PS: We have 11 RNs, an LVN, five Medical Assistants, three clerical staff, a business manager, and a nursing director. A nurse manager model is also employed. The RNs function as either case managers or staff RNs, and duties rotate frequently. Case managers collaborate with the physicians in deciding patient management strategies and keep the physicians aware of the current situation for each patient. Other team members work doing patient intake or follow-on care.

TWC: What are some characteristics of your facility?
PS: We have 20 exam rooms including four larger procedure rooms, eight rooms with beds, 12 with podiatry chairs that are able to accommodate our patient population. We also have two overhead sky lifts that help lift heavy patients (up to 700 pounds), as well as patients that cannot transfer with assistance. Our hospital has a no lift policy. Two picture archiving and communication system (PACS) workstations are available for radiology viewing. This allows instant access to digital radiographs, CT angiograms and MRAs. The Laser Doppler is used for vascular perfusion assessment. Celleration MIST Therapy (Celleration, Inc., Eden Prairie, Minn) is another technology we use on a frequent basis.

TWC: Is your center independently managed or overseen by a management company?
PS: Independently managed: We initially had a contract with Curative and that contract was terminated in June 2002. An independent business manager was then hired to handle the business and marketing functions.
TWC: What were the center’s initial challenges?
PS: Finding appropriate space. Since opening, the clinic moved from an offsite location in the first year to an in- hospital site in the second year. At year 14, we moved offsite again to a newly constructed building across the street from the hospital. Training staff was originally done by the Curative, but we now do this in-house.

TWC: What efforts have been made in advertising and/or marketing?
PS: Physician outreach, occasional radio and newsprint ads, quarterly mailings, nursing home outreach. The physician-to-physician contact is really the most effective tool. Since 90% or our referrals come from physician offices; they are the best marketing contact. We have also put on periodic physician education dinners.

TWC: How have you incorporated computer technology into the center’s workflow?
PS: Computerized scheduling is through the Misys Vision system (MISYS Healthcare Systems, Raleigh, NC). We are in the process of implementing an electronic medical records (EMR) system. The Misys EMR will be implemented at all of O’Connor’s outpatient clinics. We also use digital photography for patient documentation. All imaging is linked through the PACS system.

TWC: What have been some of your biggest operational challenges?
PS: Physician retention and staff communication; also, recruitment of management. The clinic is operating well due to the organized staff and willingness for all the staff to help out with extra work. We like to think of ourselves as a family.

TWC: What sets the center apart from other facilities?
PS: Longevity, size, MD and RN expertise, educational programs that we host, and wound care research. We are dedicated to a collaborative, team oriented approach.

TWC: What trends are you currently noticing in wound care?
PS: Increasing technology, wound care being established as a discipline, tendency for emergency room MDs to transition to Wound Care practice. Patients are getting older and seem to have more comorbidities. There seems to be increasing interference from both managed care organizations and from government entities in the day-to-day practice. n