Chronic Wound Management

Why is Transformation of Chronic Wound Management important?

• There is a significant opportunity to improve outcomes and cost-effectiveness in management of patients with chronic wounds (ulcers) in the UK.
• There is unwarranted variation in wound outcomes for chronic wounds across the UK and best practice is not consistent at a national level.

• The range of chronic wounds affecting patients includes diabetes foot ulcers, leg ulcers, pressure ulcers and complex wounds.
• Serious impact on patients with high social and personal cost due to reduced quality of life and productivity.
• There is variable compliance with NICE and national guidelines.

References: 1,2,3,4,5,6,7,8

Transformation of Chronic Wound Management – the why

“Health economic burden that wounds impose” Guest et al (1)

This pivotal health economic study estimated the prevalence of wounds (all types) managed by the UK’s National Health Service (NHS) in 2012/2013 and the annual level of resources spent in managing patients with these wounds. The study used retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database.

Key Findings

The annual NHS cost of managing these wounds and associated comorbidities was £5.3 billion.

Approximately 30% of wounds lacked a differential diagnosis.

Model estimates 2.2 million wounds were managed by the NHS (2012/2013), equivalent to 4.5% of the adult population.

Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits.

Sixty one per cent of all wounds healed in the study year; 79% of acute wounds healed and 43% of chronic wounds.

The study did not account for cost of wounds that had not healed at end of the study period.

Transformation of Chronic Wound Management – the why

“Health economic burden that wounds impose” Guest et al (1)

The study identifies some of issues leading to the high burden of wound care in the NHS:

• Lack of involvement of tissue viability nurses and other specialist nurses in the management of patients with wounds
• Inconsistencies in differential diagnosis of wounds
• Gaps in compliance with National guidelines
• Poor care pathway processes
• Variance in staff competencies with wound management

Key Recommendations 

(1) the need to refer patients to a specialist for investigation and a differential diagnosis with a shared management plan to be implemented in the community. Leg Ulcer management identified as a key opportunity for improvement.

(2) training of non-specialist clinicians in the fundamentals of wound management.

(3) Improved systems of care to support better wound outcomes.

Resources for further information

1. Health economic burden that wounds impose on the National Health Service in the UK.

Guest JF, Ayoub N, McIlwrait T, Uchegbu I, Gerrish A, Weidlich D, Vowden K, Vowden P.

BMJ Open.2015;5(12):e009283. doi:10.1136/bmjopen-2015-009283,
Link here

2. The Smith and Nephew Foundation: Skin Breakdown – The Silent Epidemic. Posnett J, Franks P.J. (2007). The cost of skin breakdown and ulceration in the UK. Smith and Nephew Foundation, Hull

4. The resource costs of wound care in Bradford and Airedale primary care trust in the UK. Vowden K, Vowden P, Posnett J. (2009). Journal of Wound Care; 18: 93- 102.

5. NHS England. A Framework for nursing, midwifery and care staff, Leading Change, Adding Value. [Online] 2016. [Cited: 11 October 2016.] Link here.

6. Srinivasaiah N, Dugdall H, Barrett S, Drew PJ. A point prevalence survey of wounds in north-east England. Journal of Wound Care. [Online] 29 September 2013. [Cited: 23 December 2016.]
Link here

7. Wounds research for patient benefit: a 5-year programme of research. Cullum N, Buckley,H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Gonclaves PS, Soares M,Stubbs M. 13, s.l. : National Institute for Health Research, Programme Grants for Applied Research, Vol. 4. ISSN 2050-4322.

8. Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. [Online] [Cited: 10 October 2016.]
Link here.