References
The characteristics and impact of hard-to-heal wounds: results of a standardised survey
Abstract
The effective management of hard-to-heal wounds has increasingly important implications for those who provide wound care services within healthcare systems. The burden of wounds in the population continues to grow, as does the demand for wound care, against a backdrop of cost constraints and increasing expectations. The need to improve both outcomes and efficiency in wound care is therefore paramount and the time taken to heal wounds is an important factor in determining both. Survey methodology was used to collect data across 10 community wound care providers in the UK, Ireland, Finland, Norway and Denmark between February and August 2017. This allowed for analysis of wounds and their characteristics, dressing selection and nursing practice across a typical wound caseload. Data from 1057 wounds demonstrates that the characteristics and consequences of hard-to-heal wounds are different from improving wounds. However, wounds are, in general, treated in the same way, irrespective of whether they are hard-to-heal or improving, suggesting that the healing status of a wound is not a major factor in treatment selection. Early intervention to return hard-to-heal wounds to a healing trajectory may be a useful approach to improving efficiency in wound care.
A substantial body of work has been devoted to defining the biological mechanisms responsible for wound healing. The terms ‘hard-to-heal’ and ‘recalcitrant’ have been applied to wounds that do not follow the normal processes of repair and as a result may not respond to standard treatment.1,2 These wounds may enter a non-healing phase, triggered by one or more factors that stop the process of normal healing.3 The reasons for this may be related to the wound itself, to events external to the wound or to an underlying medical condition.3
The effective management of hard-to-heal wounds has increasingly important implications for those who provide wound care services within healthcare systems. The burden of wounds in the population continues to grow,4 as does the demand for wound care, against a backdrop of cost constraints and increasing expectations.5 The need to improve both outcomes and efficiency in wound care is therefore paramount and the time taken to heal wounds is an important factor in determining both.6 Consequently, developing an understanding of hard-to-heal wounds to propose potential solutions is of interest. Although the biology of wound healing has been studied extensively, the characteristics of hard-to-heal wounds as treated in routine clinical practice are less well known and deserve attention.
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