On 30 June 2010, Wounds International held an international masterclass on wound diagnostics in Manchester, UK. The masterclass focused on current and future perspectives of wound diagnostics and was chaired by Professor Keith Harding (Cardiff University, UK) and Dr Douglas Queen (Cardiff University, UK).

SESSION 1

Professor Harding welcomed the delegates and highlighted the growing focus on diagnostics in the field of wound care. The first session addressed the need for better assessment and diagnostics in wounds and Professor Peter Vowden (Bradford Royal Infirmary, UK) was invited to open the discussion with the surgeon's view on 'predicting where to cut and what will heal'. 

While surgical procedures have been performed for millennia, Professor Vowden reminded delegates that many questions about the healing of incisions made by surgeons remain unanswered. Wounds are complex and the pathways to non-healing are multiple; various factors such as the level of skill of the attending nurse and abnormalities in skin metabolites - to name but a few - lead to failure to heal. While a number of diagnostic tools may be useful in directing surgeons where to cut (eg trancutaneous oxygen pressure [TC0₂P; Ruangsetakit et al, 2010), their application to practice is low, being time consuming to apply, costly, frequently unavailable in non-research settings or simply lacking the specificity and sensitivity to be applicable in individuals. Following Professor Vowden's discussion, a delegate commented that TC0₂P is less used in European healthcare settings, while in the USA preoperative TCo₂P assessment is imperative.

The nurse's view on knowing what to do with a wound and when to do it was provided by Kathryn Vowden (Bradford Royal Infirmary, UK). Kath reflected that while the range of products in wound care management is extensive, the diagnostics are not yet available to direct choice and aid clinical decision making on issues such as when to start and when to stop a treatment. Audit data from Kath's own wound healing unit suggest a high degree of uncertainty in dressing choice among nursing staff, primarily characterised by the inappropriate overuse of antimicrobial dressings. To address this, cheap, point-of-care tests, linked to therapeutic directions are needed. Kath hoped that, in the near future, wound care as a field will move from reactive, intuitive choices to proactive, evidence-based strategies for healing.

A delegate commented that many clinicians simply do not have the basics of care right and there may be negative outcomes where diagnostic tools are introduced without the appropriate supporting education. Kath agreed, saying that new technologies should always be implemented as part of an holistic support for healthcare professionals in the clinical decision-making process. Professor Harding wondered whether diagnostic developments maybe driven by patients. Kath agreed that diagnostics would provide patients with answers, especially those whose wounds are chronic and are frustrated by the lack of a definitive reason why.

In the final presentation of the first session, David Gray (Grampian Health Services, UK) gave delegates an insight into the clinical manager's view of modern wound care. David said that commissioners and managers hold the just expectation that all departments be in-line with clinical excellence, national guidelines, budgetary constraints and the wider organisation goals of the service in which they operate - and wound care is not exempt from these expectations. David described the need to put the wound care 'house' in order, using the example of his own service in the north of Scotland. This has successfully integrated itself in the wider Grampians healthcare service, established an e-clinic that empowers non-wound specialist colleagues in their wound management choices and so reduced inappropriate referrals and improved service access. Advancement of the wound care field within the wider healthcare environment is contingent, David said, on developing viable services that do not exist in isolation or fail to contribute to wider organisational goals.

Professor Harding suggested that the development of centres of wound care excellence maybe contingent on the presence of a visionary manager or 'champion'. David agreed that a 'champion' can be one way of gaining support for a service. There are also lessons to be learned from industry, David said, and clinicians need to 'sell' their service in the boardroom, showing how they are able to contribute to what managers and commissioners want to achieve (eg  preventing admissions, promoting early discharges and cost-effectiveness). Given current financial constraints, Professor Harding asked David how managers and commissioners might be 'sold' on investing in wound diagnostics. Proving to managers and commissioners that best practice has occurred and that the next question about the wound - as part of a structured pathway of care - needs to be asked will be helpful, David said.