Five reasons why doctors should become wound care specialists

Due to the rapidly increasing senior population and the incidence of pressure ulcers occurring during hospital stays or residence at a skilled nursing facility, increasingly, physicians are being called on to identify at-risk patients. Doctors are also needed to accurately classify skin conditions present at admission, in order to diagnose and treat them correctly.

Further, identifying the patient who may be at risk for developing a pressure ulcer after admission to the hospital will help initiate interventions intended to maintain skin integrity and prevent skin breakdown. For reasons such as this, understanding how to treat wounds and pressure ulcers expands a doctor’s knowledge base in a way that is increasingly needed.

According to the National Institutes of Health (NIH), pressure ulcers have recently attracted the attention of the medicolegal community. Some courts regard pressure ulcers as evidence of elder abuse, and following this precedent, in 2008 the Center for Medicare and Medicaid Services instituted a policy to withhold reimbursement to acute-care hospitals for the costs of treating pressure ulcers.

Moreover, some lawsuits have awarded judgments of more than $10 million, which may not be covered by medical malpractice insurance when the pressure ulcer is considered to indicate elder abuse. It is for reasons such as this that understanding how to treat wounds, and pressure ulcers can significantly improve the quality of care delivered and ameliorate liability to hospitals and skilled nursing facilities.

The National Library of Medicine recognizes pressure ulcers as a relevant contributor to hospital stays. They write, “Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis.”

Stated another way, after adjusting for the admission predictors of length of stay by multivariable analyses, one study found that length of stay for those who developed pressure ulcers remained significantly greater than for those who did not develop pressure ulcers (16.9 vs 12.9 days, respectively).

When adjusted for the occurrence of nosocomial infections and other complications, the difference in length of stay was even greater (20.9 vs 12.7 days, respectively). What results like this illuminate is the role that effective treatment of pressure ulcers plays in shortening hospital stays.

Compared to patients who do not develop pressure ulcers, patients who develop pressure ulcers are more likely to develop nosocomial infections and other hospital complications. As well, nosocomial infections and other hospital complications add to the additional utilization of health care among patients at risk for pressure ulcers.

In an overview of co-morbidities and pressure ulcers in the older population, the National Institutes of Health found, “the pathogenesis of pressure ulcers is a multifactorial process involving inflammatory factors, hormonal changes, reduced immune protection, impaired blood perfusion, and degenerative changes.” These immune changes can then place the patient at increased risk of further health complications.

Many refer to pressure ulcers as the final end of the pathway of accumulating comorbidities of high severity with complicating conditions. Reducing the incidence and shortening the healing time of pressure ulcers does significantly reduce comorbidity and improve patient outcomes.

As patients with many medical conditions may be at higher risk for pressure ulcers, it is important that physicians recognize that even in the ambulatory care environment appropriate prevention and detection strategies are needed.

As the NIH notes, “the tremendous variability in pressure ulcer prevalence and incidence in health care settings suggests that opportunities exist to improve outcomes for persons at risk for and with pressure ulcers.” Physicians who are certified in wound care have the ability to recognize the risk factor for pressure ulcers and respond in ways that reduce their incidence.

The growing rate of the aging population also means a growing rate of many diseases such as diabetes, renal failure, cardiovascular disease, arthritis, osteoporosis, hypertension, and Alzheimer’s disease. As all of these conditions can potentially place the patient at risk for developing wounds and pressure ulcers, doctors who can effectively treat wounds and pressure ulcers don’t just expand their knowledge base and improve quality of care, but they also respond to patient need, reduce comorbidity, and shorten hospital stays.