4 May, 2021
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 Significance Of Wound Monitoring
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.
It is generally accepted within the wound care community that the lack of accurate wound information is unfortunately a common occurrence. 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.
The Effects Of Poor Wound Monitoring
Unfortunately, using traditional techniques accurate wound data is not easy to gather. The tools used to gather the information are often neither accurate nor user-friendly, and with many different people of varying skill levels assessing wounds, the resulting data is often inaccurate, inconsistent, and unreliable.
Wounds that are not effectively monitored or detected can cause significant financial and clinical trouble for providers, not to mention an enormous amount of suffering for patients. Poor wound surveillance can contribute to penalties for hospital-acquired pressure ulcers (HAPU), infected surgical wounds, re-admissions, and ongoing litigation. As the costs and consequences of wounds escalate, it makes sense that providers should ensure they have the ability to vigilantly monitor wounds.
What Is Wound Surveillance?
Understanding chronic wounds begins with an effective surveillance system capable of gathering high-quality data and images. Wikipedia defines surveillance as the monitoring of changing information for purposes that include management, direction, and protection. Wound surveillance can therefore be defined as a precise, comprehensive form of ongoing wound information gathering.
What Is The Purpose Of Wound Surveillance?
The purpose of wound surveillance is the systematic collection, analysis, and dissemination of accurate data about wound behavior to improve healing outcomes. Wound surveillance provides an essential overview 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.
5 Benefits Of Wound Surveillance
When equipped with 3D wound surveillance, practitioners and researchers have the ability to:
- Manage wound-related risks more effectively using reliable evidence-based data.
- 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.
Why Accurate Wound Assessment Is Important
“Good surveillance does not necessarily ensure the making of right decisions, but it reduces the chances of making the wrong ones.” Alexander D. Langmuir. Accurate wound data helps facilities to avoid the risks associated with traditional wound assessment methods. We all know lack of accuracy can be costly and time-consuming. Wounds are deceptively difficult to navigate, there is a lot more to them than meets the eye.
Facilities lacking reliable wound information collection are at risk of making misinformed wound management decisions leading to re-admissions, penalties, and other negative consequences. The inadequacy of wound information becomes readily apparent if an adverse event such as a suspected hospital-acquired pressure ulcer prompts a scramble to make sense of piecemeal documentation. What’s more, facilities are hampered from systemic improvement and innovation if inaccurate wound data prevents them from distilling meaningful insights or patterns.
Wound Assessment vs Wound Surveillance
Traditional wound assessment and electronic wound surveillance systems are two very different methods of monitoring wounds, learn more about the differences below.
Wound assessment is a basic component of all wound care. At the point of care, a practitioner – often without specialized knowledge of wounds – inspects, measures, images, and documents each of the patient’s wounds. Despite the time and effort applied, the data collected is of questionable efficacy, having used traditional and two-dimensional measurement techniques, capturing digital images of inconsistent quality, and not necessarily conforming with documentation standards. Over time, this results in the accumulation of a generally unreliable body of information.
The field of wound surveillance mitigates the risks associated with traditional wound assessment by providing accurate and comprehensive wound information free from cumulative error. Electronic wound surveillance techniques enable practitioners to systematically track the true progress of wound healing, and make more effective clinical decisions. Standards for data quality – particularly its accuracy, timeliness, and completeness – are increasingly common in healthcare. Technology can enable the collection of more sophisticated and precise information, minimizing the opportunities for human error in complex activities like wound management.
What Does Effective Wound Surveillance Look Like?
The best control of chronic wounds starts with an effective surveillance system. 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.
6 Criteria For Effective Wound Management
The concept of surveillance is, of course, not new to healthcare – for instance, population surveillance is a common epidemiological approach. This body of knowledge provides an understanding of the features that comprise effective and methodical wound surveillance. The Field Epidemiology Manual lists six criteria to assess the quality of data and information, and the systems used to process and deliver them. These six criteria have been adapted to demonstrate the conditions for a high-quality wound surveillance system.
- Accuracy. Is the wound information being gathered sufficiently free from error to be fit for purpose? The recording of accurate and precise measurements enabling practitioners to derive reliable healing trends that are both statistically robust and clinically meaningful.
- Timeliness. Can all authorized wound stakeholders, such as practitioners, multi-disciplinary team members, clinical managers, and administrators access the wound information they need when it is needed?
- Completeness. Is the wound information sufficiently complete to be fit for purpose, to support complex decision-making, and for administrative and informatics purposes?
- Reliability. Is the wound information objective and credible? Can the results be replicated? Is a transparent method used to obtain the data?
- Relevance. Is the wound information contextually appropriate? Does it include the most important metrics?
- Delivery. How easy and user-friendly is the wound information-gathering process? Does the information gathered improve productivity across the facility? Providing consistent, standardized, and comprehensive documentation that is easy to gather and check.
Modern wound surveillance uses 21st-century technologies to create a systematic, facility-wide platform for wound monitoring, capturing accurate and consistent data, and obtaining reliable healing trends. This allows the hazards of wound management to be more confidently and successfully navigated, mitigating wound-related risks to all stakeholders, and helping organizations to achieve sustainable system-wide improvements.
For more information on adopting evidence-based wound surveillance, this White Paper delineates the problem with traditional methods and lays out an innovative, 21st-century solution to the challenges of wound surveillance: Evidence-based Wound Surveillance: A Three-Dimensional Approach To Measuring, Imaging, and Documenting Wounds (21 pages, PDF).