The stretch between the operation and the post-op visit
A surgical wound spends most of its recovery out of the surgeon’s sight. The patient goes home or to a facility, a family member or a nurse handles the dressing, and your office learns how it went at the post-operative visit or through an after-hours phone call.
Wound follow-up for vascular and surgical practices fills in that stretch. Gateway Wound Care arranges visits from partner clinicians in homes, skilled nursing facilities, rehabilitation centers and assisted living across Greater St. Louis and the Metro East. We coordinate the scheduling, records, supplies and communication around those visits.
Wounds your practice may hand off
- Incisions that have opened or are healing by secondary intention, including dehisced surgical wounds
- Groin and leg incisions after bypass or vein harvest, where drainage and swelling need watching
- Amputation sites between post-operative visits
- Open wounds on a limb after revascularization, where the question is whether the wound is now progressing
- Wounds on negative pressure therapy after discharge
- Skin grafts and donor sites in the early weeks
- Patients finishing treatment for a surgical site infection whose wound needs checking on a schedule
Your instructions travel with the patient
Surgeons have specific preferences, and those preferences get lost when a patient changes settings. Send your post-operative instructions with the referral: the dressing and how often it is changed, weight-bearing and activity limits, compression or elevation, when sutures or staples are due out and who removes them, and what should prompt a call to your office.
We put those instructions in front of the visiting clinician and whoever does the dressing changes at home or in the facility. The visiting clinician still makes their own assessment at each visit. If a finding conflicts with the standing instructions, that is a conversation between clinicians, and we coordinate the contact.
What gets reported to your office
Tell us who should receive updates, by what route, and for which findings. For example:
- Separation of the incision, or new or increasing drainage
- Spreading redness, warmth, odor or fever
- A change in color, temperature or sensation in the limb beyond a revascularization
- Problems that interrupt negative pressure therapy
- Missed visits, or a patient who is not able to follow activity limits
Gateway is not an emergency service. Heavy bleeding, a limb that suddenly turns cold, pale or very painful, or a patient who becomes confused or short of breath calls for 911, not a coordination call.
Referrals in the other direction
Partner clinicians regularly meet wounds that will not progress without a surgeon or vascular specialist: a leg or foot ulcer with signs of poor inflow (see arterial and mixed wounds), a wound that may need operative debridement or coverage, a wound with a possible deeper infection.
When the treating clinician asks for a vascular or surgical opinion, we handle specialist referral coordination: gathering records and studies already done, scheduling, and transportation arrangements. If your office has intake requirements for new patients, tell us what they are and we assemble the packet to match.
What stays with the surgeon
Decisions about the operation and its aftermath are yours: revision or reoperation, drains, suture and staple removal if you want it done in your office, activity clearance, and the medications you prescribed. The visiting clinician is responsible for the care given at their own visits. Gateway makes no clinical decisions.
How follow-up services are billed during a post-operative period is a matter for the treating practices and their billing staff. Gateway does not make that determination, and coverage depends on the treating provider, the patient’s plan and the care needed.
How to start
Your office can reach us at 314-325-0126, by fax at 314-786-7966, or through the referral request form, which takes contact details only. Clinical records go by fax: the operative note or a summary, discharge instructions, the medication list, any culture results and the date of the next visit with you.
The handoff works better when it starts before discharge. If your patient is still in the hospital, the referral can be made alongside the discharge plan, as described on our page about wound care after hospital discharge. Visit availability is confirmed by location and care setting.
Independent practices can also read about practice support for vascular practices, a separate service from patient referrals.
Common questions
Can a wound clinician see our patient during the post-operative period?
Yes. Visits can be arranged between your post-operative appointments when the patient is at home or in a facility. The visiting clinician has the instructions you send, and changes are reported to your office. Billing during that period is a question for the treating practices and their billing staff, not for Gateway.
How will we hear about a problem with an incision?
Through the contact and route your office chooses, such as a nurse line, a fax number or a named staff member. Clinical concerns go clinician to clinician, and we coordinate the contact. Tell us at referral what your threshold is. Some surgeons want to hear about any new drainage. Others want a call only for specific findings.
Do you coordinate negative pressure wound therapy after discharge?
Yes, when the treating clinician orders it. We coordinate the device and supply orders, the visit schedule for dressing changes, and communication among the surgeon, the home health agency or facility, and the family. Device coverage depends on the patient’s plan and the supplier. Our page on wound VAC therapy at home explains how the pieces fit.
Can you help a patient get to our office for a post-op visit or a study?
We can coordinate transportation arrangements for outpatient appointments, tests and procedures, including confirming the time with your office and the ride with the patient or facility. What transportation a patient qualifies for, and who pays for it, depends on the plan and the patient’s situation.