Dr. Brian Liljenquist
“A limb saved is a life saved.” It’s a simple credo, but one that has driven Dr. Brian Liljenquist throughout his entire career.
Dr. Liljenquist has the experience, knowledge, and statistics to back up his well-deserved reputation as an authority on wound care, but he isn’t using his talent and skill to merely impress attendees of a surgical convention or to disseminate a message from some lofty podium. He is wholly immersed in the diagnosis, application, and progress of this area of medicine. He is, in essence, a “quarterback” for this specialty and he’s making the all-star plays that not only make him an MVP but have led to a merited position in the Hall of Fame.
In 2017, in a progression from his podiatric surgical practice, where wound care was a significant portion of treatment, Dr. Liljenquist founded a national program called Wound Excellence & Limb Salvage (“WELS”) Care. This program provides care providers with insight on how best to identify the etiologies that contribute to wound degeneration and on how best to apply that understanding to complex wound care. WELS Care focuses on the prevention of below-knee amputations. Over two dozen providers nationwide are now operating with WELS Care protocols to help them provide better wound care. This care occurs in coordination with a growing number of regional and national WELS Care partnerships, including skilled-nursing facilities, home health agencies, hospitals, physicians, surgeons, and other specialists—each committed to saving at-risk patients from extremely high mortality rates associated with amputation.
Since its inception, what is now the WELS Care program has helped thousands of patients, and through Dr. Liljenquist’s protocols, they have achieved a six-week wound closure rate of 92%. The irrefutable proof is that the program has helped patients achieve a higher quality of life with significant cost reduction, which has resulted in a net positive impact on the health care system. With outcomes such as these, it is no wonder that Dr. Liljenquist was invited to Washington, D.C., to participate in creating legislation that has already shaped the future of wound care.
We spoke with the good doctor to learn more about the evolution of wound care, WELS Care’s role in the drastic decrease in mortality rates for amputations, and what this means for hospitals, health care administrators, and assisted living facilities.
First, Dr. Liljenquist, let’s talk about what compelled you to found WELS Care.
My interest for helping at-risk patients intensified during my podiatric surgical training at the George E. Whalen Veteran’s Hospital in Salt Lake City, Utah. My exposure to hundreds of complex chronic wounds instigated a desire to create better options for this particular patient population. It was there that I felt the full magnitude of the principle, a limb saved, is a life saved. Non-traumatic, below-knee amputation has a 45% one-year mortality rate and a 50% 5-year mortality rate. A bilateral, non-traumatic below-knee amputee has a 90% 5-year mortality rate, and 68% of below-knee amputees go on to lose their other leg within two years. Unilateral amputation has a greater mortality rate than many forms cancer. Those statistics alone merited better solutions than what was available.
How does the WELS Care program improve those critical statistics?
All over the country, the wait for admission to an at-risk wound program, if such is even available, is lengthy and time is such a critical factor in wound treatment. A patient might go to an emergency room with sudden symptoms, but typically, they’re discharged with only antibiotics and instructed to follow up with a wound care clinic. Often, patients aren’t made to understand how serious the problem is, and while they wait for an appointment at the clinic, their wound continues to worsen. It’s a system that isn’t working very efficiently.
What we’re trying to do with our community-based programs is be available to treat these patients quickly. By intervening aggressively and earlier, we have a better chance of treating the wound before it leads to an amputation, which can ultimately result in death. One of the most important things that a WELS Care provider learns is how to quarterback a wound patient. Through our programs, we are delivering the education and resources to help at-risk patients achieve a higher quality of life with reduced costs and a net positive impact on the health care system.
How does WELS Care effect such impressive results?
When we talk about at-risk patients, we’re speaking specifically about the type of wound that won’t heal. Many of these patients are long-term smokers or have genetic diseases, diabetes, or cancer, so they’re not healthy enough for the body to repair the wound on its own. The wound becomes chronic and often is infected, then can progress to the point where bone is exposed, and we have to start thinking about amputation. The program, in its granular form, coordinates a continuum of care from hospital discharge to healing. We have a network of specialists who understand the causations and urgency of the condition and can devise a treatment strategy for the best prognosis.
How does WELS Care differ from other wound clinics?
First and foremost, we focus on the underlying etiology—i.e., why does the patient have this wound? We find that through this approach, we are better equipped to repair the problem in one step and prevent recurrence. Another key differentiator is the expanse and consistency of our services. Through our own offerings and those of our partners, we can treat almost anything. We have a network of specialists and interdisciplinary teams, who, unlike other clinics, stay engaged with the patient long after they’ve healed. We provide post-treatment checkups and remain connected to the patient to monitor their health and avoid future occurrences.
How does WELS Care help to reduce costs to the payor?
Patients with open wounds are usually seeing a doctor every week—for years. Because we treat the wound immediately and aggressively, it reduces the cost burden on the payor—whether the patient, the hospital, the home health care agency, etc.— especially with regard to avoidable amputations. More importantly, if we are able to treat underlying etiology and educate patients on how they can participate more effectively in their own healthcare, we anticipate fewer re-ulcerations which greatly reduces cost.
How does WELS Care help medical and assisted living facilities keep residents in their own private residences and improve their quality of life?
One of the most important ways we do this is by our outbound rounding. This saves the facility money by eliminating the cost for transportation and transportation staff. The facilities usually have one van for 200 residents, so it becomes a logistics nightmare to get everyone where they need to go. It’s not just wound care; we are adding primary care services, and we often do their primary care for the patients inside the facility. It’s all about the quality of life for the residents and their families. This eliminates the need for family to leave work in order to escort the patient to the doctor. It also saves the patient from the physical demands of leaving the facility and the subsequent disruption of their activities. It’s always better for the patient to avoid travel, especially during COVID.
How does WELS Care work with home health care agencies to improve quality of life for their patients?
Traditionally, in a given community, home health care agencies are a catchall and oftentimes relied upon to perform wound care. This generalized model is not always in a good position to detect the need for treatments like sharp debridement that are often medically necessary for patients to heal. This puts patients at a disadvantage in that they are unable to receive medically necessary treatments in that context. Our mission with home health care agencies is to educate them on how to follow WELS Care protocols so that they know exactly when to seek physician orders and are equipped to act within their scopes of licensure to effect better outcomes. Teamwork has contributed greatly to our high success rate in wound closure; nurses are enabled to support patient care post-surgery, and because they take part in our interdisciplinary team meetings, they know the wound care census and plan. We’ve also implemented methods to track and communicate about patients in a HIPAA-compliant way. The feedback that we get is that nurses feel empowered because they know exactly how our providers want the care performed. We’ve made the process uniform, with best practices on dressings and treatments, and they can reach a provider quickly if they have questions. We’re on one team. It’s not hierarchical. It’s truly a partnership in patient care.
Can you tell us a bit about your collaboration with primary care providers and specialists in optimizing patient care?
Again, if we go back to one of the most important pillars of success for our wound care program, it’s focusing on underlying etiology. So, we’re communicating with the primary care providers about how we’d like to implement change. We’re working closely with physicians and specialists to apprise them of what we’re seeing and how treatment can be effectively coordinated. We often work with cardiologists and endocrinologists, as well as other medical fields, because when patients and providers are coordinating with each other, we’re better prepared to heal a wound and can prevent more from happening.
How did the WELS Care Program help providers and patients navigate COVID to ensure that wound care was not disrupted?
Many of our patients that live in facilities are over 65, immunocompromised, and at high risk for COVID. Most facilities locked down, so if a resident left for treatment, they had to be on a 7–14-day quarantine when they returned. What we saw was a lot of isolation from two different angles. The first was that patients had stopped leaving because didn’t want to be quarantined. With their normal routines disrupted, they were lying and sitting down more so we saw an increase in skin integrity breakdown. The second group of patients, who did leave the facility, were hit the hardest. In quarantine, they were confined to their rooms and in bed all the time. We saw four patients who developed full-thickness wounds in the shoulder joint from sleeping on their sides for so long. Those patients all had to go to a plastic surgeon to avoid loss of the arm. In response to this crisis, we increased our in-facility visits but developed safety protocols wherein providers got tested up to twice weekly and were given protective gear. If we had not done that outbound rounding, I believe we would have seen a significant increase in amputations.
Dr. Liljenquist, you’ve certainly made a measurable impact in your field. What motivates you? What do you enjoy most about your work?
With so many patients considered “at risk for amputation,” it’s extremely fulfilling to know that I’ve helped a great many of them out of that category. The programs we design through collaboration, and those that I’ve implemented, have been hugely successful in accelerating treatment and the results have been profound. It’s so satisfying to meet a patient who’s had a wound for a year, get them into our program, and heal them, and I’ve been afforded the opportunity to work with so many deeply committed facilities and health care practitioners. They’re appreciative of what we’re doing, catch the vision participate, and that is very rewarding.
Thank you for your time, Dr. Liljenquist, and for sharing these incredible advancements in wound care.
Dr. Liljenquist is the multi-year recipient of the “IFAH Top 100 Leaders Award.” The International Forum on Advancements in Healthcare recognizes thought leaders for their valuable insights and successful participation in the industry. He completed his undergraduate studies at University of Nevada, Las Vegas, then attended Ohio College of Podiatric Medicine, where he earned his Doctor of Podiatric Medicine (DPM) degree before completing a podiatric surgery/RRA from The Intermountain Medical Center.
Contact:
Dr. Brian Liljenquist
WELS Care
LI: www.linkedin.com/in/brianliljenquist