Clinical audit and effective change in leg ulcer services

Area of Science:

• Vascular Surgery
• Community Nursing
• Health Services Research

Background:

• Clinical leg ulcer services require efficient and effective management strategies.
• Previous models like the Riverside project demonstrated success in leg ulcer treatment.
• An audit identified areas for improvement in existing leg ulcer services.

Purpose of the Study:

• To audit and re-audit clinical leg ulcer services in South Bedfordshire.
• To implement research-based methods for leg ulcer assessment and treatment.
• To evaluate the effectiveness and cost-efficiency of community-based leg ulcer clinics.

Main Methods:

• Adaptation of the Riverside model for patient referral and management.
• Doppler ultrasound assessment to determine the Ankle-Brachial Pressure Index (ABPI).
• Treatment protocols based on ABPI values: high compression for ABPI >0.8, reduced compression for ABPI 0.6-0.8, and specialist referral for ABPI <0.6.

Main Results:

• Community clinic treatment reduced consumable costs (£7.91) compared to home treatment (£10.78).
• Weekly treatments and nursing time were reduced with community clinic care.
• High compression treatment in community clinics achieved 54% healing after 12 weeks and 68% after 24 weeks.

Conclusions:

• A standardized system of care, including staff training and research-based assessment, is effective for leg ulcer management.
• Community leg ulcer clinics offer rationalized services with improved cost-effectiveness.
• While healing rates were slightly lower than the Riverside project, differences are attributable to patient population and ulcer duration.