Hospitalists’ Engagement - Barriers in Wound Care Management

Minimal academic focus is placed on provider knowledge of skin/wound related etiologies. A University of Miami Study found that only 7 of 55 medical schools had formal wound care rotations ¹_. Reimbursement and benchmarks are directly connected to provider documentation based on coding guidelines.  Evidence based management may be compromised as skin/wound concerns are perceived as nursing issues² _. Financial, organizational, interprofessional, and patient outcomes are adversely impacted by gaps in provider’s wound care knowledge and management.  WOC nurses are pivotal change agents in translational wound care.

 To determine hospitalists’ current knowledge, practices, and perspectives related to standard management of pressure injuries (PIs) and neuropathic ulcers. To identify interprofessional, educational, and system barriers as a process improvement opportunity.

  A Qualtrics™ based survey focused on knowledge, practice, and perceived barriers in wound care assessment and management was devised, piloted, and resulted.

Seventy two percent of respondents (55% of total hospitalist) reported not having any formal training in wound care.  Over 90% had little or no confidence in management of PIs. Respondents selected lack of knowledge/confidence and resources  as number one barriers to wound care. Seventy two percent of respondents did not realize pressure injuries must be documented by provider within 24 hours to avoid hospital acquired code.  One third of hospitalists attended focus group sessions post survey.

The hospitalist team serves as frontline health care providers setting the trajectory course for wound clinical outcomes, organizational key performance measures, and financial recourse. Engaging providers promoted viable problem-solving strategies to improve knowledge, processes, and system barriers.

Acute care hospitalists reported lack of confidence, knowledge, and resources to optimally manage patients who have wounds. WOC nursing professional practice is critical in minimizing gaps related to interprofessional wound care management and preventable patient harm.