Vascular referral coordination for wounds in St. Louis.

Why circulation matters for a wound

Skin needs a steady blood supply to repair itself, and veins need to carry blood back out of the leg. When either side of that system is not working well, a wound on the leg or foot can stall. Vascular referral coordination for wounds is how Gateway helps a clinician’s order for testing or a specialist visit become a completed appointment with results in hand.

Gateway does not decide who needs a referral. The treating clinician examines the patient and writes the order. We coordinate what follows, which is where referrals often get lost.

Vascular studies a clinician may order

The choice of test depends on the wound, the exam and the patient’s history. Common examples:

• Ankle-brachial index (ABI). Blood pressure readings at the ankle and arm are compared to estimate blood flow to the lower leg.
• Toe pressures. A similar measurement at the toe, sometimes used when ankle readings are unreliable, as can happen with diabetes or kidney disease.
• Arterial duplex ultrasound. Shows blood flow through the arteries and where it may be narrowed.
• Venous duplex ultrasound. Looks for clots and for vein valves that let blood flow backward.

A clinician often wants arterial results before ordering compression, because squeezing a leg with poor arterial flow can cause harm. Our guide to circulation tests before compression explains more.

Specialists who may be part of the plan

Depending on the cause of the wound, a treating clinician may refer to:

• A vascular surgeon or other vascular specialist, for artery or vein disease
• A podiatrist, for foot structure, calluses and pressure relief
• An infectious disease physician, for deep or hard-to-clear infection
• A plastic or general surgeon, for surgical closure
• A dermatologist, when a wound does not look typical for its presumed cause

For patients at risk of losing part of a foot or leg, these referrals are central to limb preservation.

What Gateway coordinates

1. Confirm the order. We check that it names the study or specialty, the reason and any urgency the clinician has stated.
2. Send records. With permission, the testing site or specialist receives wound notes, measurements, medication lists and prior results.
3. Schedule. We find a time that works for the patient, family or facility, and ask about any plan authorization the office requires.
4. Arrange the trip. We help with transportation arrangements suited to the patient’s mobility, and pass along any preparation instructions.
5. Return the results. Reports go to the ordering clinician, who decides what they mean for the wound plan.
6. Follow up. If an appointment is missed or a report does not arrive, we pursue it.

Appointment timing is set by the specialist’s office or testing site, so we cannot promise a date.

At home and in facilities

Some circulation checks can be done with portable equipment during a visit, when the treating practice offers it. Others need a vascular lab or a specialist’s office.

For residents of skilled nursing, assisted living and memory care, an outside appointment takes planning. We coordinate with the nursing team on transport, an escort if needed, the paperwork that travels with the resident, and how new orders get back to the facility. Facility teams can use our guide to transport coordination for outpatient wound visits.

Closing the loop with primary care

With permission, reports also go to the primary care clinician, who manages the conditions behind many circulation problems: diabetes, blood pressure, cholesterol and smoking. Our page on circulation and vascular health describes that side of care.

If a specialist changes the plan, we update home health, facility staff and the supplier so dressing and compression orders match.

Signs that should not wait for an appointment

Call 911 for a foot or leg that suddenly turns cold, pale or blue, sudden severe pain in a limb, or sudden numbness or inability to move it. These can be signs that blood flow has been cut off.

Tell the treating clinician promptly about skin turning black, foot pain at rest or at night that eases when the leg hangs down, spreading redness, fever, or a wound that is quickly getting larger.

How to start

Patients and families can call 314-325-0126 or use the request care form, which collects only a name and phone number. If no clinician is following the wound yet, we can arrange an assessment first. Clinicians, facilities and practices can refer a patient or fax orders to 314-786-7966.

Common questions

Related pages

• Circulation and vascular health
• Circulation tests before compression
• Limb preservation
• Arterial and mixed wounds
• Vascular and surgical practices
• Refer a patient
• Advanced wound care
• Chronic wound care