The BIOMES℠ Tool: An Approach to Recognizing Wound Severity for Early Intervention and Referral to a Specialist

The escalating prevalence and incidence of individuals with chronic, non-healing, or hard-to-heal wounds is staggering and poses significant financial burdens on the healthcare system. Initial wound evaluations and assessments are often performed first by urgent care, emergency responders, or even general medicine professionals who are skilled practitioners but are not chronic wound specialists and may have only received a limited amount of education or training specific to wound care. As a result, these medical providers may not be familiar with current wound care scoring systems that aid in determining wound severity, guiding early interventions, and identifying the need for specialized care based on patients' overall medical condition and wound status. A referral to a wound care specialist has the potential to expedite healing, reduce the overall cost of care, alleviate patient suffering, and ultimately, save a limb or a life. The blood flow, infection, offloading, metabolic issues, and exudate, social (BIOMES℠) tool is a coined acronym that can be used by any healthcare provider to quickly identify whether a patient should be referred to a specialist by classifying a wound as low, moderate, or high risk for delayed healing. Blood flow, infection/bioburden, offloading/overloading, metabolic/morbidity, exudate/edema, and social/economic barriers are assessed, and 1 point is assigned to each barrier that can be identified as a red flag with the potential to affect the healing trajectory of a patient's wound. Wounds are classified as follows: low risk: no barriers; moderate risk: 1 BIOMES℠ barrier; high risk: 2 or more BIOMES℠ barriers. Any patient identified as moderate or high risk should be referred to a wound care specialist in hopes that earlier, more aggressive wound care and medical management will result in improved wound healing versus traditional wound management. Addressing these barriers is essential for wound management and improved outcomes, especially in lower extremity care.