Wound Clinic in General Practice
Junction Place Medical Centre (JPMC) is a busy general practice located in one of Melbourne’s eastern suburbs. General Practice Nurse Jodie Gartner started developing the wound clinic so that local patients could access quality wound treatment without travelling further to wound specialists or vascular surgeons. The clinic runs two days a week.
“I felt wound care wasn’t done particularly well in general practice, nor was it cost-effective for the practice. I think for patients this meant their wounds took longer to heal.”
Junction Place Medical Centre GP, Dr Simon Wong said having a dedicated practice nurse for wound management was good for GPs’ time management and quality of patient care.
“Nurse clinics should be expanded in the context of a large clinic – they should have a complementary role to medical practitioners, and contribute to clinic decision-making. Areas of practice that would lend themselves to nurse clinics would include dermatology, women’s health and diabetes –all chronic health problems.”
See how the Wound Clinic applied the building blocks in establishing their clinic
See the patient flow and MBS items used in the Wound Clinic
A clear plan
The high number of existing patients in need of wound care at the centre highlighted the potential of a specialised clinic. The goal was to give wound patients a better quality of care. Practice management were helpful in setting up a business plan around costs, likely demand, time involved and potential benefits.
The wound clinic is funded entirely through existing Medicare Benefit Scheme item numbers. Patients see a nurse, and a GP attends during the consultation.
A major cost with a wound clinic is dressings. At Junction Place, before the existence of the wound clinic, practice nurses were changing dressings and not charging for products, creating a financial loss for the clinic. With the start of the wound clinic, guidelines were set up for how to bill patients for products, or guide them to buy and bring their own, and lost costs began to be recovered. Also, greater expertise in wound conditions and care enables nurses now to be more informed in choosing dressings, and more selective with expensive products.
Location and facilities
A lot of wound patients are elderly and have lower leg wounds. Access to mechanically adjustable furniture is a benefit not just for them but for health care staff as well, to avoid back strain. A treatment room at Junction Place with a height-adjustable bed is helpful, but is prioritised among the large practice staff for the greatest patient need.
Staffing and HR
Initially there were concerns about separating out the role of wound care to a specific clinic, however, with a focus on improving the quality of care delivered in the practice, the team gradually came on board.
One doctor was responsible for seeing every patient in the wound clinic until the model was changed so the patient’s own doctor was brought in where possible, spreading the learning through the clinic.
The clinic follows Wounds Australia (previously Australian Wound Management Association) clinical guidelines for wound care, and quality improvement processes impact not just the clinic but the entire practice.
The clinic nurses assess the patient and wound, assist with determining aetiology and factors that influence healing, create wound management plans, provide wound care and educate the patient.
The clinic has done very little marketing, finding sufficient business within the practice’s existing clientele. But word of mouth has been effective, as well as a good relationship with the local pharmacy, who send prospective patients across to the clinic. A new on-site podiatrist is expected to also refer to the wound clinic.
The initial clinic model was more around specialist wound care but focus shifted to a model that was more accessible and affordable for patients.
Supporting systems and processes
Consistency in wound care and dressing technique is prioritised across the Practice, right down to the way dressing trays are opened. The clinic aims to stay up to date with evidence based best practice, and as this changes in response to new research, policies around procedures in the Practice change too, and are circulated throughout.
Evaluation and improvement
As the clinic has grown a specialised body of knowledge about wound care, patients are less often referred to specialist wound clinics or vascular surgeons. A steady and sustainable flow of patients is regarded as a sign of success, with the clinic seeing 6-10 patients a day. Continuity of care has been improved, with wound management plans created and adhered to consistently between different practitioners.