title: Suboptimal identification of patient-specific risk factors for poor wound healing can be improved by simple interventions.
abstract: Poor wound healing is an important surgical complication. At-risk wounds must be identified early and monitored appropriately. Wound surveillance is frequently inadequate, leading to increased rates of surgical site infections (SSIs). Although the literature demonstrates that risk factor identification reduces SSI rates, no studies have focused on wound management at a junior level. Our study assesses documentation rates of patient-specific risk factors for poor wound healing at a large district general hospital in the UK. It critically evaluates the efficacy of interventions designed to promote surveillance of high-risk wounds. We conducted a full-cycle clinical audit examining medical records of patients undergoing elective surgery over 5 days. Interventions included education of the multidisciplinary team and addition of a Wound Healing Risk Assessment (WHRA) checklist to surgical admissions booklets. This checklist provided a simple stratification tool for at-risk wounds and recommendations for escalation. Prior to interventions, the documentation of patient-specific risk factors ranged from 0·0% to 91·7% (mean 42·6%). Following interventions, this increased to 86·4-95·5% (mean 92·5%), a statistically significant increase of 117·1% (P < 0·01). This study demonstrates that documentation of patient-specific risk factors for poor wound healing is inadequate. We have shown the benefit of introducing interventions to increase risk factor awareness.
authors.affiliation: General Surgery Department, North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Harris
authors.affiliation: General Surgery Department, North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Luck
authors.affiliation: General Surgery Department, North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Atherton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management / Q000379:methods*; D006113:United Kingdom; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
keywords: Intervention; Risk factor; Wound healing