A Proposed Final Post-Treatment Wound Outcome-Tracking Tool

Disclaimer: The opinions, interpretations, conclusions, and recommendations are those of the author
and not necessarily endorsed by the United States Air Force.

Wound assessment and grading techniques have been well described in the literature and incorporate various approaches using wound size, attributes, location, presence of secondary conditions, such as infection, comorbidities, and other physical findings to clarify and define the wound.¹ Wound assessment should be a dynamic process that follows an orderly sequence of steps to address healing or lack thereof. Treatment modalities used for wound care often play a significant role in wound assessment.²
Periodic wound assessment should be performed using an appropriate quantitative or qualitative assessment model.³ To date, no one has published a comprehensive wound outcome tracking tool to help standardize the documentation of the final patient outcome following care at a treatment facility or clinic or by an individual practitioner. The Wound Healing Society defines a healed wound as the restoration of skin providing a return to normal anatomic structure, function, and appearance with an intact barrier function.⁴ An acceptably healed wound is defined as one in which epithelization capable of sustaining functional integrity during normal activity was achieved. A minimally healed wound is defined as one in which epithelial covering was restored without a sustained functional result and with a high probability of rewounding.⁴ These criteria define a spectrum from a healed to a minimally healed wound but do not provide a means to quantify final case results for many wounds treated by a medical practitioner. The final outcome of the treated wound should also be assessed and classified using a standardized approach.
It is anticipated that a final wound outcome-tracking tool will become more important to the wound care practitioner in the future. Insurers and healthcare organizations look for quality control measurement tools to assess outcomes and tie reimbursement to these outcomes. With this in mind, a proposed wound outcome-tracking tool is submitted for the consideration of wound care practitioners to use or modify in their practice. This assessment should be simple to apply but should specifically define what to include in each outcome category.

Proposed Final Wound Outcome Tracking Tool

Excellent/Healed: A wound will be characterized as “Excellent/Healed” when one or more of the following scenarios have occurred:
1. The patient has recovered completely from the condition for which wound care or therapy was instituted (at wound care clinic or hospital discharge) with one or more of the following (if appropriate)
2. No amputation (or additional amputation) required for referred limb
3. Skin grafting with > 95% “take”
4. No occurrence of new wound(s) during the treatment course.
Satisfactory/Improved: A wound will be characterized as “Satisfactory/Improved” when one or more of the following scenarios have occurred:
1. The patient has clearly improved, and continued improvement to resolution is anticipated following completion of therapy, wound care, or after discharge from the clinician’s care
2. Amputation was necessary, but level was distal to that which was initially anticipated before beginning therapy or wound care
3. Skin grafting resulted in < 95% but > 50% take
4. New wound(s) that are unrelated to the original wound(s) or could not have reasonably been prevented have occurred during the treatment course
5. Nonhealed wounds that received palliative care may be included here if that was the defined goal of treatment and the expected outcome was obtained.
Unsatisfactory: A wound would be characterized as “Unsatisfactory” when one or more of the following scenarios have occurred:
1. No modification of the disease course has occurred despite the institution of therapy and/or wound care, and this outcome was not expected based on the history, examination, or test results
2. A recommended amputation level that did not heal and required a more proximal amputation was conducted
3. During the treatment course, new wound(s) that could reasonably have been prevented through better care or preventive interventions developed
4. The wound(s) worsened or became larger or the patient developed secondary complications as a consequence of the wound(s).
When this category is used, an explanation should be provided/proposed as to why the expected outcome did not occur (eg, secondary infection, inadequate offloading, poor patient compliance, malignancy, etc.).
Incomplete: The wounds were improving, but the prescribed course of wound care or treatments were not completed before the wound was healed. A reason should be provided for this termination of care (eg, referring physician stopped treatment or patient was discharged to home, stopped attending treatments, was hospitalized for unrelated conditions, died, and other factors).
Inconclusive: This includes wounds with no documented progress at the time wound care or treatments were stopped. Information to determine the effectiveness of the treatment plan may not be sufficient. This term describes the outcome of treatment, not necessarily the final outcome for the patient.

Conclusion

It is hoped that this proposed tracking tool will stimulate input from the field with the ultimate product gaining wide acceptance and utilization in the wound healing community. In time, a societal consensus statement may be necessary to standardize a final wound outcome-tracking tool.