REVIEW British Journal of Healthcare Management 2017 Vol 23 No 10 491 © 2017 MA Healthcare Ltd Paul Browning Modern management in acute wound care ABSTRACT Your skin is your body’s largest organ, which when breached leads to a number of biological activities aimed at restoring normal function. Acute wounds heal spontaneously as a result of these biological functions, while those wounds stuck in a healing phase are referred to as chronic. An average CCG is managing 11 200 wounds in 2012, and set to grow to 23 000 by 2019. This article examines how wounds are classiied into a common language, and collates a number of key challenges to UK healthcare managers juggling budgets with patient outcome. This includes the CQUIN targets, CET and the importance of measuring the true cost of care rather than unit cost alone. Key Words: CQUIN • Wound • Economic • Classiication • Cost • Acute Paul Browning MSc MTOPRA FCQI CQP Doctoral Research Student Wounds today Our skin is the largest organ in our bodies consisting of several layers and several functions. Its primary function is a mechanical barrier – protecting against infection, pressure and stresses – not to mention regulating temperature and sensory responses like pain, temperature and touch. Wounds are deined as injuries to this tissue including where the skin is breached. Wounds can heal by primary intent, or secondary intent. In primary intent, the edges of the wound are brought together through medical intervention. For example, the use of sutures, staples or adhesives. Secondary intention is where the wound edges cannot, or are not brought together. Wounds healing by secondary intent are thus at increased risk of infection, and where dressings are required to modulate the wound environment to encourage efective healing. In the UK, there are an estimated 2.2 million adult wounds being treated by the NHS at a cost of £5.3 billion (Guest et al, 2015a). This NHS cost is greater than the burden incurred due to obesity-related health conditions (£4.2 billion) (Oice for National Statistics, 2014). When wounds heal efectively, the NHS cost equates to £2.1 billion per year; when compared to unhealed wounds, which cost £3.2 billion (Browning, 2014; Guest et al, 2015b) (see Figure 1 for more details). A recent publication showed that on average each CCG/Health Board was managing 11 200 wounds in 2012 – 2013, and is likely to grow to 23 000 wounds per annum by 2019 – 2020 (Guest et al, 2017). This same study conducted a health economic model in which it restricted the availability of dressings in the wound care formulary to reduce the cost by 15%. With just an estimated 3% reduction in wound healing rates resulting from incorrect dressing selection resulted in increased prevalence of wounds and associated costs. Table 1. Predicted costs per CCG resulting from reduced formulary Year # wounds Cost - 3% healing rate # wounds Cost 2017–2018 18 800 £42.7 million 19 800 £45.0 million 2019–2020 23 200 £49.0 million 25 800 £54.5 million