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Implementation of clinical algorithms in complex wound care: a pilot study on feasibility and professional acceptance
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Purpose: Mobile applications that integrate clinical algorithms have the potential to standardize wound assessment and to supportclinical decision-making across assessment, diagnostic support, and therapeutic planning in complex wound care. This pilot studyexplored the feasibility of implementing such algorithms in a mobile application and examined concordance with nurse as-sessments and professional acceptance.Methods: A prospective multicenter pilot cohort study was conducted between June and October 2023 in rehabilitation units, outpatientclinics, primary healthcare, homecare, and hospitals. Adults aged ≥ 18 years with pressure injuries/pressure ulcers, venous leg ulcers,arterial ulcers, or diabetic foot ulcers were eligible. Nurses recorded data using the CWS_Validation application at three time points over4 weeks. Agreement between algorithm-generated classifcations and nurse assessments was analyzed using Cohen’s kappa, Fleiss’ kappa,and Krippendorf’s alpha. Nurse adherence to therapeutic recommendations and perceptions of the alert system were also evaluated.Results: A total of 49 patients with 56 wounds (mean age = 79 years) were included. Pressure injuries/pressure ulcers were mostprevalent (71.4%), particularly categories 3 (25%) and 4 (23.2%). The algorithm provided diagnoses for 46 wounds, with fair overallconcordance with nurse assessments (κ = 0.41; 95% CI: 0.24–0.57). Adherence to therapeutic recommendations was high: 85.3% incomplete monitoring and 90.3% in partial monitoring. Nurses rated the alert system positively (mean = 4.34, SD = 0.82) incomplete monitoring sessions (n = 109).Conclusions: Clinical algorithms can be feasibly integrated into mobile applications and are well accepted by nurses across diversecare contexts. These preliminary fndings highlight the potential of algorithm-driven tools to support wound assessment anddecision-making, while underscoring the need for larger studies with more robust designs to confrm clinical impact.
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Palavras-chave
Clinical decision support Complex wound car Feasibility stud Mobile health (mHealth Nursing informatics Professional acceptance Wound assessment
Contexto Educativo
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John Wiley and Sons Ltd