Transforming Inpatient Venous Leg Ulcer Management Through Early Specialist Tissue Viability Intervention

Abstract

Inpatient care for venous leg ulcers is often inconsistent, with delays in vascular assessment and compression therapy contributing to prolonged healing and fragmented treatment. This evaluation examined a front-door Tissue Viability Nurse-led service providing specialist assessment at hospital admission. A descriptive service improvement evaluation was conducted. From 2022, patients in the Assessment Ward admitted with leg wounds received Tissue Viability assessment within one working day, including Doppler-based vascular evaluation, wound bed preparation, peri-wound skin optimisation and early initiation of compression therapy. Compression bandaging became a core clinical skill for registered nurses, supported by a rationalised product formulary. This observational evaluation and qualitative review suggested that early specialist involvement supported the timely initiation of compression therapy, reduced variation in inpatient wound care and minimised duplicate referrals through clear Tissue Viability-led care plans. Staff confidence in applying compression was perceived to improve, collaboration with vascular, dermatology and community services strengthened and patients informally reported clearer information and greater continuity of care, supporting a timelier approach to care delivery. Positioning Tissue Viability expertise at the Assessment Ward appeared to support improvements in the consistency and safety of care processes in leg ulcer management. This front-door specialist model, rarely described in acute care literature, enhanced timeliness and coordination and provides a scalable approach to addressing international gaps in acute wound care pathways.