Addressing the urgency in wound care: alleviating the unseen suffering in patients

13th June 2024 > 5-minute read

Jacqui Hughes

Part 1 of this continuous improvement (CI) piece focussed on the paramount importance of measuring health outcomes in the UK. Click here to read more.

This second part, focuses on NHS/industry value-based partnerships as a means of ensuring productivity improvements, efficient spending, and improved patient outcomes.

The NHS embodies a strategic vision grounded in equity, accessibility, and excellence in health care delivery. This vision is articulated through several key principles and initiatives. Its commitment to universal healthcare coverage means that there are now a multitude of specialised areas that can benefit from a continuous improvement approach. Furthermore, the NHS is dedicated to promoting health and well-being beyond the traditional boundaries which involves addressing social determinants of health to tackle health inequalities and improve overall population health outcomes.

If we believe that adopting a continuous improvement methodology should be the foundation of the NHS, then we need to consider how easy are these programmes to implement given the challenges currently faced. Continuous improvement is not a destination but a journey. It’s a certain mindset that requires cultural change and the strive for excellence at every level of an organisation.

How can we ensure that clinicians delivering care on the front line are not overwhelmed by additional workload? Put simply, CI programmes do not have to be difficult to execute, the most minimal of clinical practice changes can deliver the most robust results. Getting clinicians on board with continuous improvement programmes can be a delicate process. It is important to emphasise that these programmes are not about criticising current practice but rather about enhancing them.

NHS/industry value-based programmes can be pivotal in helping services redesign their services based on CI methodology. The benefits of such a value-based NHS/industry partnership are severalfold. Innovation and technology adoption, cost reduction through economies of scale, shared risk and reward models, data collection and analytics, and skill and knowledge exchange being some of the favourable aspects of such a partnership. Furthermore, the data provided through CI methodology can help to inform the allocation of resources while ensuring high-quality care. This supports value-based procurement strategies, where the focus is not purely on upfront cost but also on the long-term value to patients and the healthcare system.

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The following examples demonstrate the effect value-based partnerships can have not only in terms of improving the local health economy but also the patient experience, and the health and well-being of staff.

Example 1 looks at orthopaedic surgery. As the NHS grapples with a significant backlog of patients, 7.58 million* on waiting lists for elective treatment, continuous improvement programmes with the help of industry can actively reduce length of stay in hospital, reduce readmission rates, and improve patient outcomes. One area that has demonstrated positive outcomes is that of orthopaedics – this has been achieved through the identification of at-risk patients who might go on to develop surgical site complications. One aspect of this is the development of a surgical site infection (SSI). Simply changes to post operative incision care can reap several benefits.

Firstly, addressing SSIs promptly is crucial to prevent further burden on an already strained healthcare system. SSIs can lead to prolonged hospital stays, additional surgeries, and increased healthcare costs. By promptly reporting and treating SSIs, healthcare providers can mitigate these complications, freeing up much-needed resources to address the backlog of patients awaiting treatment for various conditions.

At a recent Smith+Nephew roundtable event, it was identified that there is strong awareness of surgical site infection (SSI) within orthopaedics and the part this plays in terms of readmission rates and patient outcomes. However, the reporting of SSIs is not mandated in orthopaedics, except for elective fracture neck of femur patients. Most organisations do collect data but mechanisms for reporting are often flawed, allowing for manipulation of data entry. Reporting is often published retrospectively for the previous quarter to avoid impacting scores and being flagged as outliers versus the national average. Furthermore, collection of data is resource intensive, and SSIs are frequently misdiagnosed and reported incorrectly in the community, skewing the true SSI rate. With a lack of alignment between acute and community settings this challenge is set to continue.

A value-based partnership in an orthopaedic speciality hospital where wound care technology was embraced saw the following improvements¹:

• Overall length of hospital stay reduction

• Reduced number of dressing changes

• Fourfold reduction in reported surgical wound complications

In example 2 below, you can see how positive NHS/industry partnerships can reap significant rewards within a community setting. This NHS/industry partnership example centres around the provision of wound care. Why is wound care a problem? Wound care is a significant problem in the NHS. In 2013, an estimated 11,2002 wound population could be seen across a system. With prevalence growing at 9-13% per annum², even the most conservative approximation means that in 2024, this population is likely to sit between 31,493 and 47,466 wounds per healthcare system. Thirty percent of all wounds are unhealed and as such represent a significant strain on health economies. In 2017, an estimated £8.3 billion cost was attributed to wound care across the NHS which for context, and when compared to other NHS spend in the same period, the urgency of wound care solutions is apparent:

• Diabetes care - £8.8 billion³

• Arthritis (osteo and rheumatoid) - £10.2 billion²

• Mental health services - £12 billion⁴

If there are solutions which could remove the cost of non-healing of wounds, then a reduction of £5.8 billion could be realised within the NHS, based on the conservative 2017 figures.

An NHS organisation partnered with Smith+Nephew using a value-based partnership approach with integrated continuous improvement methodology. Data analytics at several touchpoints is key to understanding the current state of the service and to identify where clinical practice can be improved. Capturing such data, facilitated by Smith+Nephew, ensures that any changes proposed to a service are strategic, measurable, and ultimately lead to better health outcomes and more efficient service delivery. This specific project, following baseline data collection, was focused on procurement of wound care dressings and nurse time. This consisted of a full review and redesign of the current end to end procurement process. This was achieved using FORMEO, a digital wound management ecosystem that simplifies the ordering process and formulary alignment. Conventional prescription routes can involve an average wait time of 5 days, which can potentially lead to delays in patients receiving optimal treatment and increase the risk of further clinical complications⁴. The impact this has on resource and capacity can be seen in the time is takes chasing and collecting prescriptions from pharmacies, which was averaging at 2.31 hours per week. Furthermore, a considerable reduction in waste can be realised as any unused dressings can be used by other patients as the traditional prescription route is completely bypassed⁵.

By using this tailored solution, following baseline and post implementation analytics the organisation saw the following outcomes:

• 26,809 nurse visits were saved

• Wound dressing volume reduced by 17%

• 12% year on year saving 

• 27% reduction in time spent of admin tasks relating to dressing supply

Following the success of this project, Smith+Nephew are working with the organisation looking at other aspects of wound care that can be improved with an added emphasis on levels of deprivation and health inequalities that are part of their strategic objectives.

Conclusion

Value-based partnerships are essential for the NHS to navigate the complexities of modern healthcare delivery. By collaborating with stakeholders who share its commitment to quality care, the NHS can leverage expertise, resources, and innovation to improve patient outcomes while optimising costs. These partnerships foster a culture of shared responsibility, where all parties are invested in achieving common goals such as enhancing access, efficiency, and patient experience. Furthermore, value-based partnerships enable the NHS to harness diverse perspectives and approaches, leading to the development of more comprehensive and sustainable solutions to healthcare challenges. In an era of increasing demand and finite resources, these collaborations empower the NHS to deliver high-quality care that is both effective and cost-effective. Ultimately, by prioritising value-based partnerships, the NHS can strengthen its resilience, adaptability, and ability to meet the evolving needs of patients and communities across the UK.

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