Abstract 17944: Process Mapping Care of Patients With Lower Extremity Wounds Due to Chronic Limb Threatening Ischemia

Background: The care experience for patients with wounds due to chronic limb threatening ischemia (CLTI) is rarely understood. Quality improvement programs frequently fail to recognize the entire process involved in accessing care. We developed a process map for stakeholders to guide quality improvement for CLTI patients.

Methods: We recruited a team of stakeholders, including nurses, providers, coordinators, and patients, and met through iterative meetings to create a process map. We categorized barriers, identified actors, and estimated wait times. Based on information gathered, targeted solutions to improve care were developed.

Results: We mapped 2 pathways, inpatient hospitalization and outpatient evaluation, for CLTI patients seeking care. Within these 2 paths, we identified 25 action steps with 15 decision points. We identified a total of 105 barriers to patients accessing care in each pathway. These were mapped into 9 categories grouped into multiple patient factors, health systems resources, insurance, communications, and waiting. We also identified 40 actors whose role in the process could create barriers within the process, including family, translators, social services, insurance. Finally, we grouped solutions into 4 categories. Overall, the shortest time to treatment was mapped as 8 weeks with expedited care to over 1 year with care provided solely in clinic.

Conclusion: Process mapping highlights the great lengths patients endure to get treatment as well as specific opportunities for improving care between systems, providers, patients, and families. This work should serve as the foundation for quality improvement programs for patients with CLTI.