Using Science to Advance Wound Care Practice: Lessons from the Literature
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Index: Ostomy Wound Manage. 2012;58(9):16–31.
Wound care professionals can improve clinical, patient-oriented wound outcomes and do so cost-effectively by using scientific evidence to meet patient and wound care goals and needs. A review of the literature was conducted to define evidence-based wound management, describe the potential of science to improve outcomes in wound care, and summarize strategies, tactics, and tools for wound care providers and recipients to utilize science to their mutual benefit. In addition, changes in the availability of randomized and nonrandomized and clinical and preclinical evidence during the past 50 years were examined using MEDLINE database searches of English-language publications, combining the search terms wound, ulcer, or burn limited by the terms randomized or clinical for each decade since 1960. The number of published, nonrandomized wound studies has increased exponentially during the last five decades but, more recently, evidence from randomized controlled trials also has become available. Moreover, while many questions remain unanswered, a substantial number of publications have shown the use of available evidence-based guidelines and wound care strategies improves outcomes of care while saving time and money. The application of science-based wound care in clinical practice is increasing slowly; expensive techniques supported by limited or inconsistent evidence are still in use and add to wound care costs without certainty they improve outcomes. The literature provides compelling evidence that patients with a wide variety of diagnoses benefit when opinion-based care is replaced by clinical wisdom applied on a substrate of best available evidence. Patients with wounds deserve no less.
This article is based on the John Boswick Memorial award lecture presented at the Symposium on Advanced Wound Care, Gaylord Texan Conference Center, Dallas, TX. April 16, 2011.
Keywords: evidence-based practice, wounds, review literature, treatment outcome
Potential Conflicts of Interest: Dr. Bolton discloses she is a consultant or paid advisory board member for ConvaTec (Skillman, NJ), Derma Sciences, Inc (Princeton, NJ), EuroMed (Orangeburg, NY), and Systagenix Wound Management (Quincy, MA), as well as an expert witness for Gordian Medical (Irvine, CA).
Wound care spans current medical specialties, and although it is not prominent in its own right on the healthcare horizon, its weight as a medical subspecialty is increasing. A meta-analysis1 of venous and pressure ulcer clinical studies has shown good wound care can dramatically reduce use of medical resources and costs while improving patient outcomes. The global economic burden of wound care is approaching $20 billion,2 excluding burdens of reduced quality of life, independence, or capacity to work or interact with others, as well as the burden on overworked providers in all settings.
According to a 2009 literature review,3 in the US, more than 5.7 million individuals have chronic wounds that might have been prevented or might heal faster using evidence-based (EB) care; and many more postsurgical wound-related complications such as infection, amputation, deep vein thrombosis, or pressure ulcers (PUs) could be minimized using EB surgical and peri-operative care. Wielding evidence can help wound care professionals and recipients spend less while improving outcomes.