Evidence and practice in Primary care: Optimising the assessment and management of lower limb wounds in general practice

The new, peer reviewed research by Julie Green, Gillian Boast, Robin Calderwood et al, was conducted with the aim to educate about the following points:

Enhancing the knowledge of the potential benefits of using an automated device instead of a Doppler assessment to measure and calculate ankle-brachial pressure index (ABPI) ratios,

Raising awareness of how a specific leg ulcer pathway could improve wound care and management from primary care onwards,

Understanding how optimising the care of patients with lower leg wounds could bring significant time and cost savings.

The Staffordshire, England-based project that the article covers was launched primarily due to patients with an existing complex lower limb wound or other vascular concerns often being referred from the general practice to other services, resulting in significant delays in assessment and treatment.

To combat these issues, a service improvement project was developed to provide a pathway for high-risk patients: automated ABPI devices (by MESI) were supplied to 19 GP surgeries and one community vascular clinic in the project region, with adequate training, protocols and project leadership provided.

General practice nurses undertook automated ABPI readings for patients with a wound or vascular concern and provided appropriate care. Patients with complex wounds and those with vascular concerns were referred to other services where appropriate. This article also dives into the results of the service improvement project and its effect on patient care.

More about the project

The project, which was kicked off in November 2018 and concluded at the end of September 2019 enabled timely assessment of 145 patients with an existing lower limb wound or vascular concern. The 145 automated ABPI readings obtained through automated ABPI measurements required an estimated 24 hours and 10 minutes in total, while assessments with Doppler would require about 145 hours; the measurement with automated ABPI devices becomes faster, simpler and more accurate, which suggests there is cope or increasingly widespread implementation of ABPI testing earlier, within the general practice (»..for example during NHS health checks«), requiring minimal additional consultation time, but resulting in significant cost savings for the management of PAD and »…other vascular conditions before patients become symptomatic.«

The conclusions regarding the impact of this project that the article draws are the following: »…These patients also received enhanced management as a result of their care remaining within general practice, and the project demonstrated improvements in the management of patients presenting with lower limb wounds or vascular concerns. Retaining patient care in general practice also reduced referrals to other services. It is essential that findings from this project are disseminated to other areas of the UK to inspire similar service improvement projects.«