Strategies to reduce practice variation in wound assessment and management: The T.I.M.E. Clinical Decision Support Tool
Published:
Authors: Alison Garten, Andrea Bellingeri, Dot Weir, Ewa Sturmer, Gulnaz Tariq, Henri Post, Joanna Swan, Keryln Carville, Lee Ruotsi, Michael Clark, Rolf Jelnes, Shinobu Ayabe, Terry Swanson, Zena Moore
There are many reasons for practice variation in wound management. There is no universal solution to reducing or removing variation in clinical practice, so greater standardisation may be required to help structure how clinicians assess and manage wounds.
Effective assessment is a key aspect of setting patients and their wounds on the path towards an optimal or appropriate outcome. An International Core Expert Working Group met in September 2019 and explored the many factors that influence standardisation of care. For the purposes of this WUWHS consensus document, the international core expert working group chose to specifically consider use of the T.I.M.E. Clinical Decision Support Tool (T.I.M.E. CDST) as a means of standardising the assessment and management of wounds in order to reduce practice variation.
The T.I.M.E. CDST has evolved from the original TIME concept, which was developed by Schultz et al, and provided a structured approach to wound bed preparation. The concept considers four aspects – the type of Tissue within the wound, the presence of Infection and Inflammation, the Moisture balance and the appearance of the Edge of the wound.
To expand the value of TIME to clinicians caring for patients with wounds, a clinical decision support tool has been developed to embed the TIME concept firmly within recent advances in knowledge base and to offer a holistic assessment of the patient and their wound(s) through the initial ABCDE approach. The ABCDE approach translates the identification of the underlying causes and patient needs into practice (Appendix A – T.I.M.E. CDST product-specific and non-product-specific versions).
This document seeks to help clinicians support those who do not have specialist wound training to accurately assess patients and their wounds and arrive at a broad-based, systematic rationale for their selection of local wound treatments that will ultimately help reduce variations in clinical decision-making.
Supported by an educational grant from Smith + Nephew
Download the PDF to access the full consensus document.
