New approaches to wound care

James G. Spahn, MD, FACS

Pressure ulcers are a significant problem across all healthcare settings in the United States. Annually, 2.5 million patients are treated in acute-care facilities for the condition. Patients with pressure ulcers are three times more likely to be discharged to a long-term care facility than those who do not have the wounds. Also, pressure ulcers are more likely to occur among those over age 65. Since that demographic is expected to double within the next 25 years, the number of individuals with pressure ulcers is expected to increase exponentially. Additionally, pressure ulcers are now developing more frequently than ever before in patients under the age of 65.


These common wounds are both costly to treat and potentially deadly to patients. Regulations imposed by the U.S. government (Present on Admission vs Hospital Acquired) penalize healthcare providers severely by requiring them to absorb the costs associated with treating pressure ulcers-a cost of $30,000 each on average. Furthermore, lawsuits related to wound care abound and the average summary judgment in these cases is $247,000. With such high stakes, LTC providers must take immediate action.

These common wounds are both costly to treat and potentially deadly to patients.

When considering the vast array of dynamic variables at play in the LTC setting, it is no surprise that patients’ health can be compromised due to the complexity of sorting through acquired data.

The identification, diagnosis, tracking and management of pressure ulcers can be among the most complex issues involving patient care. Patient data includes multiple attributes and is obtained from numerous sources across several facility sites, spanning several acuity levels and time series.

In practice, a clinician’s judgment in the choice of pressure ulcer prevention and/or treatment for an individual patient is based, to an extent, on theoretical considerations derived from an understanding of the nature of the illness. But it is based also on an appreciation of statistical information about diagnosis, treatment and prognosis acquired either through personal experience or through medical education. The important argument is whether such information should be stored in a rather informal way in the clinician’s mind, or if it should be collected and reported in a systematic way. No clinician-no matter how thorough and intelligent he or she may be-has the ability to personally acquire enough factual information when compared to that which can be obtained from technology and statistical models. It is partly by the collection, analysis and reporting of statistical information that a common body of knowledge is built and solidified.

The truth is that the amount of on-hand knowledge needed to deliver appropriate preventive and/or treatment care for pressure ulcers has become so vast that even highly specialized clinicians have trouble keeping current with new information relevant to their professional area of focus.

Addressing the multisource, multi-attributable information related to pressure ulcers across the continuum of care is integral for LTC providers and their patients. As they adopt new methods, they must help integrate and analyze data based on each patient and his or her given situation. Upon analysis, effective care plans that address all the potential risk factors for each patient can then be extrapolated to ensure proper prevention and/or treatment and desired results. It is important for caregivers to have access to patient data at the point of care. When face-to-face with a patient, a clinician must be able to obtain and utilize all available medical information to make critical determinations regarding the direction of patient care.


The organization and trending of data is a relatively new area of activity when it comes to patient analysis, pressure ulcer management and overall treatment. During this process, a software solution is generated to assist the caregiver in designing an acceptable outcome for the patient. Ideally, these refined data processes can be implemented into a system that gives LTC providers clinicians the freedom and confidence to authorize treatment for their individual patient needs.


Another new approach to wound care and pressure ulcer prevention, detection and treatment is thermographic imaging. Thermal imaging cameras depict internal variations in energy associated with metabolic activity when used on the human body. Because there is a two- to seven-day delay-at times greater-for most pressure ulcers to be clinically recognized from the time of the caused event, it is important for LTC providers to be proactive in detecting pressure ulcers as early as possible.

Through the use of thermographic imaging, deep tissue injuries can be detected in the subcutaneous tissue, which is invisible to the naked eye. The thermal infrared image, along with a visual digital image, can identify the at-risk soft tissue and skin area. The recognized area of interest can then be sequentially followed to see if resolution or evolution is occurring. The dual image solution can be useful to identify, evaluate and track the area of interest. This imaging process can assist in the time of occurrence recognition, status of area of interest, physician/provider diagnoses and subsequent care plan development.

The bedside knowledge acquired through the use of organized, trended data and thermographic imaging provides considerable assistance to providers. A few of the many intrinsic benefits include: proactive involvement with patients; essential bedside knowledge; evaluation of care plan analysis; thorough documentation; educational information for caregivers, patients and their families; and the meaningful use of electronic health records.

Thermal imaging provides a noninvasive, nonradiating means to assess physiologic activity below the skin’s surface to locate at-risk areas that are not yet visible to the naked eye. In addition, predictive modeling is able to use patient data and apply advanced algorithms to provide unbiased risk assessments.


As new innovations for pressure ulcer prevention and detection are adopted in the LTC setting, the opportunity for improved care plans continues to arise. Although these are new approaches to wound care, they are in no way required to replace facilities’ current protocols relating to pressure ulcer prevention and treatment. Instead, they are meant to provide caregivers with a holistic view into each patient’s physiologic status to better define and portray the differing effects support surfaces or related wound care initiatives have on the soft tissue of each patient. As a result, individualized care plans can then be extrapolated to ensure the proper matching of support surface and intervention methods to each individual patient’s needs.

As new innovations for pressure ulcer prevention and detection are adopted in the LTC setting, the opportunity for improved care plans continues to arise.

James G. Spahn, MD, FACS, is the Founder of EHOB, Inc., and a wound care expert dedicated to the prevention and treatment of pressure ulcers. For more information, call (800) 899-5553 or visit Long-Term Living 2011 August;60(8):44-45

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