J Tissue Viability. 2025 Jul 14;34(4):100938. doi: 10.1016/j.jtv.2025.100938. Online ahead of print.
ABSTRACT
BACKGROUND: We surveyed primary and secondary care health professionals to describe the care and referral pathways for treatment, including surgical reconstruction (SR), for patients with a severe pressure ulcer (SPU).
METHODS: We administered three online surveys comprising closed and open-ended questions (free text comment boxes) to healthcare professionals working in primary care, nurses who look after patients with severe PUs in any setting and surgeons (11, 30 and 22 questions, respectively). Participants were recruited through professional organisations, contacts of study team members and through social media. We calculated descriptive statistics for the closed questions and used principles of thematic analysis to analyse the free text comments.
RESULTS: There were 59 primary care (76 % GPs), 146 nurse and 45 surgeon respondents. Most nurses worked in hospitals (60 %) or the community (55 %) and almost all (93 %) were trained in wound care. Most surgeons were plastic surgeons (79 %) in consultant roles (81 %). Over half of primary care respondents did not know SR is a treatment option to close SPUs and had never referred patients with SPUs to secondary care for a surgical opinion. Nearly three quarters of nurses (72 %) considered SR for a SPU and over half (54 %) believed that SR to close a SPU should be more widely available. Surgeons reported that SR was not performed for most referred SPU patients; but two thirds (68 %) believed that SR should be more widely available. There was good agreement about which patients are suitable for SR. The free-text analysis identified both system-level (e.g. lack of care pathways, dedicated multidisciplinary teams, resources) and patient-level (e.g. patient lifestyle, behaviour and preferences) factors influencing patients’ access to SR.
CONCLUSIONS: Our surveys highlighted that nurses and surgeons agree about which SPU patients are suitable for SR but lack of awareness, the absence of an established referral pathway and lack of multidisciplinary teams are barriers to access to SR.
PMID:40759061 | DOI:10.1016/j.jtv.2025.100938
