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Cost of nurse-led surgical wound care and management treatment plans assessed 

Analysis of cohort of anonymised general practice patient records reveals wound-healing inconsistency

Analysis of cohort of anonymised general practice patient records reveals wound-healing inconsistency 


Picture: Alamy

Surgical wounds which fail to heal by primary intention are problematic for patients. Nurses are involved in such wound care, but the extent of resource use and health outcomes are unknown.

This secondary data analysis of a cohort of anonymised general practice patient records in University College London's Health Improvement Network database addressed these issues.

A retrospective cohort of 707 patients were identified, who had an unhealed surgical wound after four weeks. Patient characteristics, health outcomes and resource use were quantified. Patients were mainly aged over 60 years (58%), had a mean number of five co-morbidities and most had planned surgery (71%).

Patients’ wounds were mainly managed by district and practice nurses. Wound documentation and wound healing terminology were inconsistent. Mean time to healing was four months, with 83% of wounds estimated to have healed in 12 months. Up to 68% of wounds were infected or at risk of infection at initial presentation.

Surgical team follow-up

Only about half of the patients, who had unhealed surgical wounds at three months, had a recorded follow-up with the surgical team, and only three patients had a recorded referral to a tissue viability specialist nurse.   

The combination of dressings and bandages prescribed at the initial presentation remained unchanged for most patients, irrespective of length of time. There was little evidence of treatment plans or re-evaluation of healing.

The cost to the NHS of managing an unhealed wound was at least double a healed wound (mean of £5,997 vs £13,682 per wound 2015-16 prices). District nurse visits accounted for more than 50% of the costs. Recommendations were made on consistent terminology and treatment plans.


Reference


Vari Drennan is professor of healthcare and policy research at Kingston University and St George’s, University of London

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