Complex wounds, such as venous leg ulcers (VLUs) and pressure ulcers are prevalent, costly and negatively impact on patients’ health-related quality of life. No robust data is nationally or locally available that describes the number of people with complex wounds being cared for by NHS community services and the nature of their complex wounds and care.
We surveyed community wound care across five NHS Trusts (patient population of almost 2 million), the first community-focused multiservice survey capable of examining variation in treatment and care of complex wounds between NHS Trusts.
The survey found unwarranted variation in practice between Trusts, together with underuse of evidence-based interventions and overuse of interventions supported by limited evidence, examples below:
- Use of silver-containing dressings, which are associated with a higher cost than a basic dressing for little or no known patient benefit varied from 18%-69%. Overuse of such interventions could utilise resource that would confer more benefit elsewhere.
- In total, 31% (range 24-44%) of patients with VLUs were also not being treated with compression therapy, the gold standard treatment for VLUs, suggestive of suboptimal care. We estimated implementation of optimised evidence-based VLU care (including use of compression) could save as much as £118,979 for every 100 patients with a VLU.
We are focused on developing strategies to disinvest in products and practices supported by little or no evidence and enhance the uptake of those that are, increasing the value of community-based wound care, and reducing unwarranted variation.
Partner NHS Trusts have reported changes in clinical processes and practice due to survey findings.
Contibution of CLAHRC Greater Manchester
The work was led by Professor Dame Nicky Cullum, the academic wound care programme lead for NIHR CLAHRC GM, in partnership with five NHS provider Trusts. The NIHR CLAHRC provided:
- Academic research expertise
- Project management support
- Facilitation support to support completion of the survey within partner organisations
- Communication support to aid effective dissemination
This work built on Professor Cullum’s previous work undertaken as part of an NIHR Programme Grant for Applied Research- ‘Wounds research for patient benefit: a 5-year programme of research’.
What happened next?
The research has been published and the following impact identified:
- Direct influence on the national NHS England ‘Leading Change Adding Value-Improving Wound Care’ Project.
- Development and delivery (with two NHS Trusts) of the ‘Improving Leg Ulcer Management in Community Nursing (ILUMIN)’ project.
- Partner NHS Trusts have reported changes in clinical processes and practice due to survey findings.
- Results have been widely presented locally and will inform future GM-wide work in this area.
- Work underway with Connected Health Cities GM, exploring electronic capture of wound care data. Further related grants under consideration.