24 June, 2014
By Mark Nixon, MD
“You cannot convert the absence of information into a conclusion,” Jack Ryan, the hero of the Tom Clancy thriller The Sum of All Fears advises the US President, who is struggling to make sense of a complex military situation. Misinformation aggravates the complexity and confusion in the book, illustrating what can go wrong when information is neither accurate nor timely.
Like commanders-in-chief, health providers need accurate, timely and complete information if they are to make progress in their defense against the incursion of chronic wounds.
The bad behavior of wounds
Wounds can be covert operators, remaining under the radar if not monitored effectively. Sen, Gordillo, and Roy’s 2010 article Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy notes that the significance of wounds as a major health problem has been overshadowed. They attribute this to the fact that wounds are usually the secondary diagnosis of “highly branded” diseases such as diabetes and obesity, and can therefore be overlooked.
There is acceptance in the wound care community that there is not enough accurate information about wounds. For instance, although the prevalence of chronic wounds is similar to that of heart failure, little is known about the outcome of wound patients or about the comparative effectiveness of the treatments they receive.
Wounds that are not effectively monitored and detected can cause significant financial and clinical trouble for providers. Poor surveillance can contribute to penalties for hospital-acquired pressure ulcers (HAPU), infected surgical wounds, readmissions, and litigation. The suffering to patients can be enormous.
As the costs and consequences of wounds escalate, it makes sense that providers should ensure they have the ability to vigilantly monitor wound behavior.
What is wound surveillance?
The word surveillance comes from a French phrase for “watching over”. Surveillance has also been defined as “information for action”. Wikipedia defines surveillance as the monitoring of changing information for purposes that include management, direction and protection.
We distinguish wound surveillance as a more precise, comprehensive form of wound information gathering than is currently used in wound assessment.
Wound surveillance is the ongoing and systematic collection, analysis and dissemination of accurate data about wound behavior to improve healing outcomes. It provides an essential oversight of the entire wound care effort, identifying discrepancies so they can be addressed immediately. Importantly, modern wound surveillance rejects inaccurate techniques that would misinform and mislead clinicians and other wound stakeholders.
With effective, precise wound surveillance, facilities can:
- More effectively manage wound-related risk using reliable evidence;
- Improve wound-related multidisciplinary team communication across multiple and remote sites;
- Oversee non-specialist wound assessments to improve point-of-care practice;
- Improve patient comfort and compliance;
- Make better-informed treatment decisions that enable more effective healing.
Wound surveillance is the ongoing and systematic collection, analysis and dissemination of accurate data about wound behavior to improve healing outcomes.
Accurate wound data
Unfortunately, accurate wound data is not easy to gather using traditional techniques; the tools gathering the information are often neither accurate nor user-friendly. With many people of varying skill levels assessing wounds, the resulting data is often inaccurate, inconsistent, and unreliable.
The control of chronic wounds starts with an effective surveillance system gathering high quality data. This comes from:
- Accurate and precise measurements enabling practitioners to derive reliable healing trends that are both statistically robust and clinically meaningful;
- High quality imaging;
- Consistent, standardized and comprehensive documentation that is easy to gather and check.
This surveillance should be easy for authorized wound stakeholders to access. It should support quality protocols and the best use of skills, such as multi-disciplinary team input and the knowledge of wound specialists.
As Jack Ryan advises, it is only when you have verified that your information is accurate and reliable that that you can confidently reach the correct conclusions.
This blog is Part 1 of the Wound Surveillance Series. Read Part 2 here.
Document number: 2014-00230