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Wound care is a large and growing challenge for the NHS. The NHS spends an estimated £8.3 billion each year on wound management, a figure that will continue to balloon with our ageing population. Guest et al’s research into the scale of the problem showed a 71% increase in the prevalence of wounds between 2014 and 2018, resulting in a 48% increase in the cost of patient management. The landscape of wound care is evolving, demanding a closer look at the challenges faced by healthcare professionals and a new approach to addressing these sustainably in a manner which improves patient outcomes.
Wound care - the scale of the issue
A chronic wound is defined by its persistent nature, resisting healing for a duration of six weeks or more. These wounds encompass a spectrum of conditions that demand specialised attention and resources to facilitate recovery.
The NHS manages 3.8 million patients with chronic wounds annually, a figure that grows 12% every year and that translates to 7% of the adult population. This results in 54.4 million district/community nurse visits, 53.6 million healthcare assistant visits, and 28.1 million practice nurse visits annually for wound management. Over 70% of the cost linked with chronic wounds is attributed to healthcare professional visits by multi-disciplinary teams consisting of nurses, doctors, and healthcare assistants.
A challenge of this magnitude requires a solution which scales to address the needs of wound management holistically. This requires a streamlined process to get the advice of those with the necessary skill set and access to a real-time view of the wounds on a caseload, flagging those which are deteriorating or stagnating. For the latter, the most effective way to achieve this is by facilitating a flow of information directly from patients or their carers.
Therefore, the two key principles that are needed to optimise caseload management and improve patient outcomes are:
- Collaboration across Multi-Disciplinary Teams (MDTs)
- Greater patient involvement in their care
Principle 1 | Collaboration across Multi-Disciplinary Teams
Management of long-healing wounds is complex and often requires ongoing care. 30% of wounds in the community setting are defined as “not healing” or “hard to heal”. These long healing journeys require multiple visits by clinicians and therefore it’s crucial that the wound management solution implemented is also supported by a workforce optimisation tool.
The treatment of chronic wounds often involves the collaborative effort of different disciplines, such as community nurses, tissue viability nurses and podiatrists. In treating pressure ulcers and other serious chronic wounds, we should be harnessing these essential disciplines in real-time in order to level up wound care provision. When looking at a digital wraparound to support this, there are certain fundamental requirements.
Firstly, for every patient on the caseload, there should only be one instance of the patient’s record with the ability for different user accounts to access this at the same time, without patient record locking. The patient’s record should be live with new information presented back to clinical teams in real-time. It is also helpful for the solution to have no device requirements. This enables all clinicians to contribute to a patient’s care using existing hardware available to them. At an organisational level, this allows for the solution to be deployed at scale, maximising MDT collaboration and the associated improvements to patient outcomes and clinical productivity.
Case study
Central London Community Healthcare NHS Trust (CLCH)
PATHWAY
At Central London Community Healthcare NHS Trust (CLCH) wound care teams have been using Isla to record, share, discuss and treat their patients. District nurses can attend patients’ homes, assist and assess the patient, take an image and upload it to the platform for Tissue Viability Nurses (TVNs) and MDTs to discuss. Patients and carers can also submit images , videos and forms to the platforms for their clinicians to review.
IMPACT
- Using Isla it is 3.8 times faster for CLCH TVNs to complete a review, releasing 5.4% of a clinician’s working day
- In 2022/23, Isla’s implementation helped clinical teams realise £152,762 in financial savings for their Trust
- Adoption has ramped up quickly. Currently 1,000 CLCH staff are registered on Isla, treating over 12,000 patients and with the platform seeing 10,000 submissions per week.
Principle 2 | Greater patient involvement in their care
Patient-generated information is an important step towards providing scalable wound management. Whereas MDT collaboration ensures that the relevant clinicians have access to data in real-time, patient-generated information moves us towards an ideal where the data being reviewed is continuously generated in real-time. This provides an up-to-date view of a caseload and wound recovery.
Where patients are more directly involved in their care, we not only see patient empowerment, but better patient outcomes. In some cases, it might be that family members, carers or care homes submit information on behalf of the patient. Still, the impact is that the clinical team is not heavily reliant on-site visits in order to make an assessment. With all patients on a caseload submitting information at a more regular frequency than is possible with site visits, it ensures that clinical teams can prioritise their caseload effectively and provide personalised care.
To encourage supported self-care, it’s important that we lower the barriers to patient engagement. Platforms should be web-based and not require sign-in credentials in order to submit. It should be possible to add alternative contact details to a patient’s record, allowing submissions on behalf of patients where they cannot do so themselves. Lastly, remote workflows should be automated where possible. Together, these three elements allow for a new way of working to be implemented at scale and in a manner which does not increase the admin burden felt by the clinical teams delivering the transformation.
Case study
Nottinghamshire Healthcare NHS Foundation Trust
At Notts Healthcare, the wound care teams have implemented Isla to support remote-first triage and ongoing monitoring. Under this model, patients and care homes are submitting images of wounds which need to be reviewed. The clinical team is then able to prioritise site visits where it is appropriate and for those who need it most. Patient-submitted information is accessible to all clinicians involved in the patient’s care. Therefore, as was the case with CLCH, the expertise required, e.g. TVN, can be harnessed across the MDT in response to newly submitted information.
As noted in the graphic, 15% of patients who submitted an image could be managed virtually without the need for a site visit at all. Furthermore, 75% were shifted towards planned intervention, thereby enabling more effective caseload management and releasing capacity across the workforce. This not only improves patient experience and outcomes, but the results of reduced travel and increased clinical productivity have a significant impact on Notts’ commitment to net zero objectives and financial stability.
Of the images submitted to Isla for clinical triage:
IMPACT
- In Adult Community Nursing alone, Notts was able to realise annual financial savings of £155,260
- 4,702 hours of clinical time saved, equating to 196 days per year
- 27,000 travel miles saved resulting in a 4.7 tonne reduction in CO2 emissions - equivalent to planting 216 trees.
Together, an MDT and supported self-care model can realise significant benefits for patients, the clinicians delivering their care and the Trusts working towards broader organisational goals. Isla is a platform listed by the National Wound Care Strategy programme and fully interoperable with your EPR having already completed native integration with EMIS and S1.
If you would like to learn more about the benefits NHS Trusts have realised using Isla, in both wound care and more broadly, please use the contact form below to get in touch. From its inception, Isla has been co-developed with clinical and operational leaders in the NHS so reach out even if just to give feedback - we would love to hear from you.