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Bridging Over the 'Silos' of Care

Orthopaedic Surgery
December 8, 2015

James Ficke is leading an innovative plan that coordinates communication among all the departments at Johns Hopkins involved in treating traumatic limb injury.

As director of orthopaedic surgery at Johns Hopkins, James Ficke is among the nation’s leading experts on lower-extremity reconstruction. Beyond surgical excellence, his work focuses on eliminating the barriers to collaborative clinical decision-making, cutting through the “silos” of care that complex patients tend to receive. His goal? To build teams with a common, patient-oriented purpose.

When consulting after the 2013 Boston Marathon bombing, Ficke called on his experience in the Army, where he led the Department of Orthopaedics and Rehabilitation, including the Center for the Intrepid, a rehabilitation facility in San Antonio that treats victims of blast injuries.

“Serendipity brought me the privilege of caring for tremendous patients with severe traumatic injuries and then understanding how to build programs around that,” says Ficke. “What became clear was that we had young amputees who wanted to keep their lifestyle and continue doing their activities. Sitting in a wheelchair was not an acceptable option.”

Ficke recalls the high level of skill among the clinicians in the U.S. military and Boston who treated the amputees and limb-salvage patients. What he sought to bring to the environment there, and what he pursues at Johns Hopkins, is a connection among all members of the medical, surgical and rehabilitation teams to achieve outcomes that serve the needs of even young, athletic patients.

“We’ve now established a multidisciplinary amputee service and are developing strong ties for limb salvage, so that orthopaedic surgeons, including partners Greg OsgoodBabar ShafiqCasey Humbyrd and Erik Hasenboehler, as well as notable vascular surgeons, plastic surgeons, podiatrists, physiatrists, therapists, prosthetists and nurses work together to take someone who has had traumatic limb loss and get them running again.” He views this collaborative team as the spokes of a wheel, each serving as a point of entry for comprehensive care.

“It turns out that by building something like this, we give people a hope and an opportunity that really is unique to Hopkins.” This support system is driven in part by the research of the Major Extremity Trauma Research Consortium (METRC), funded through the Department of Defense. With the central coordinating center in the Johns Hopkins Bloomberg School of Public Health, METRC is the largest orthopaedic trauma research program, involving more than 30 sites around the country.

“Through METRC, we are actively working to understand how to improve outcomes for these patients,” Ficke says. “We cover both sides: the clinical side, which is multidisciplinary, and the research side. It’s a holistic approach.”

For patients who have undergone amputation and are seeking greater function, Ficke believes that collaborative clinical decision-making is a powerful approach. He recalls his first patient at Johns Hopkins, a runner seeking an amputation after seven previous surgeries. Ficke was able to return her to high function with bracing, and after physical therapy, she completed a 112-mile run across Florida.

“We carefully consider the expectations of the patient,” Ficke says. “We want to get the person, as well as the function, back.”


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