Coordinate wound care around the person, not the appointment
Our wound care coordination approach begins with a plain observation: a care plan only works if it fits the person living with it. The same wound calls for different arrangements when the patient lives alone on a second floor, shares a room in a skilled nursing facility, or relies on a daughter who works days.
So before anything is scheduled, we ask about the person. Where do they live or stay? Who helps them? How do they get around? Which clinicians already know them? The answers shape what follows.
Step one: understand what is needed
You do not need medical vocabulary or a complete history to start. In the first conversation, we want to know:
- Who needs care and where they are right now
- What kind of help is being asked for (wound care, primary care or both)
- Who is already involved, such as a primary care clinician, a surgeon, facility nurses or home health
- What has made follow-up difficult so far
- The best person to call back
The treating clinician reviews the wound and the relevant medical history. Gateway gathers the records, contacts and practical information the clinician needs for that review.
Step two: give each next step one owner
A patient with a wound may have several people involved, and each may assume someone else is handling the next task. When nobody owns a step, it tends not to happen.
We help the team sort out who is responsible for what:
- Clinical questions and changes in the wound: the treating clinician
- Daily care between visits: the patient, a caregiver, facility nursing staff or home health, as the orders direct
- Visit scheduling: Gateway, with the treating practice
- Records moving between offices: Gateway, with the offices that hold them
- Supplies and equipment: the practice that writes the order and the supplier that fills it, with Gateway following up
- Rides to outside appointments: the family, facility, health plan or a transportation provider, with Gateway helping arrange them
Our guide to building your wound care contact list shows one way to write these names down.
Step three: clear the practical barriers
Many interruptions in wound care have nothing to do with the wound. An order is missing a signature. The shipment does not match the dressing the clinician chose. The patient cannot manage the steps down to the car.
Gateway works on these details with the patient, the care team and the companies involved. That can mean following up on supply and equipment orders, asking whether a visit can take place at home, or helping a family plan transportation to an outpatient appointment. When a barrier turns out to be clinical, we bring it to the treating clinician.
Step four: keep follow-up connected
The aim is that the plan made at one visit is still being followed two weeks later, and that the next visit builds on the last. After a visit, we check on the open items: orders that were written, supplies that were requested, appointments that still need a date.
When a patient moves between a hospital, a rehabilitation center, a facility and home, the plan has to move too. Our continuity of care page covers those transitions.
What stays with the treating clinician
The treating clinician assesses the wound, makes the diagnosis, writes the orders and decides on treatment. Gateway does not offer medical opinions or change a plan of care.
If you notice a change in the wound, such as new redness, swelling, drainage, odor or pain, report it to the treating clinician. We can help you reach the right office. For an emergency, call 911.
The same approach in facilities and for referring teams
The steps hold when the request comes from a facility or a practice. For skilled nursing and assisted living communities, it means knowing who on staff is the contact for wound questions and how orders from a visit reach the nursing team. Scheduled facility wound rounds are organized around that routine.
For referring physicians and discharge planners, it means your patient’s information reaches the treating practice and you know who to call with a question. Our care coordination service page goes into the details.
Getting started
Patients and families in Greater St. Louis and the Metro East can call 314-325-0126 or use the request care form, which asks for a name and phone number only. Visit availability is confirmed by location and care setting.
Common questions
What does “a clear owner for each next step” mean in practice?
It means that after a conversation or visit, each open task has a named person or office attached to it. If a supply order is pending, you know which practice wrote it and which supplier is filling it. If records are needed, you know who is sending them.
Will Gateway replace the doctors and nurses I already have?
No. We work with the people already involved in your care. Your primary care clinician, specialists, facility staff and home health agency keep their roles. Gateway connects you with a partner clinician for wound care or primary care where that is needed, and helps information move among everyone so they are working from the same plan.
What if I do not know what kind of care I need?
That is a common place to start. When we talk by phone, describe what is happening in your own words: where the wound is, roughly how long it has been there and who has looked at it. The treating clinician decides what care is appropriate after an assessment.
How does Gateway handle communication with my family?
Tell us who you want included and how they prefer to be reached. It often works well to name one family member as the main contact for scheduling and logistics. Clinical information is shared according to your wishes and the treating practice’s privacy rules, so it helps to say early on who has your permission to receive updates.