Two Similar Cases, Two Different Outcomes

No nurse assigned:

A morbidly obese, male injured worker, 32 years old, had a heel surgery. No other co-morbidities. Six months post operatively he had what was described as a pin hole that would not close on his heel. The surgeon requested and received approval for a plastic surgeon referral. The plastic surgeon did a surgery with a skin graft from his calf. The graft site did not heal, and the flap on the pin hole wound did not adhere permanently. Six months later and this claim is still open and receiving medical treatment. Cost thus far is over $200,000.

Nurse assigned:

A morbidly obese, male injured worker, 47 years old had a heel surgery. This injured worker also had chronic high blood pressure controlled by medication. Four months after surgery he had an open hole in his heel described as nickel sized. The surgeon requested a plastic surgery consult. The nurse discussed with the injured worker and adjuster her thought that instead of plastic surgery, a wound care doctor would be appropriate. All agreed with her recommendation.

The nurse contacted the treating physician and she agreed to a wound care consultation and withdrew the plastic surgery referral.

The injured worker treated with the wound care specialist for two months and the hole closed up. The injured worker was able to resume his normally activities and returned to work. Cost of claim at closure: $68,000.


Now there may certainly have been other factors that affected these results. Maybe one injured worker was more adherent to the treatment plan than the other. Maybe one surgeon was better than the other. But the nurse recognized right away that if you send a patient to a plastic surgeon they are going to do plastic surgery. That does not bode well for a patient that you know heals poorly, especially if the wound is on the foot. Having a nurse take all of these factors into consideration and then make a sound recommendation on the direction treatment should take, can be invaluable.