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A Ubiquitous But Ill-Defined Concept: Wound Care Excellence

Salcido, Richard, “Sal”, MD, EdD

Advances in Skin & Wound Care: May 2018 - Volume 31 - Issue 5 - p 197
doi: 10.1097/01.ASW.0000532377.69820.55
DEPARTMENTS: EDITORIAL

Richard “Sal” Salcido, MD, EdD, is the Editor-in-Chief of Advances in Skin & Wound Care; the William Erdman Professor, Department of Physical Medicine and Rehabilitation; Senior Fellow, Institute on Aging; and Associate, Institute of Medicine and Bioengineering, at the University of Pennsylvania Health System, Philadelphia, Pennsylvania.

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This month’s CE/CME, “Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality,” attempts to exemplify the concept of excellence by systematizing wound care practices using a team-based model including a pathologist and microbiologist as part of an interprofessional team. The team-based protocol includes a forum similar to staging conferences such as cancer-tumor boards in oncology. As the authors rightfully conclude, in the project’s current stage of development, “a direct causality cannot be established between the implementation of a weekly wound conference, financial implications, and patient outcomes, such as a reduction in readmission, morbidity, or mortality.” To be sure, the cost of rounding with a large interprofessional team consumes more hours per full-time equivalent and incurs more direct charges for wound care unless the charges are “bundled.” However, if the team can demonstrate cost savings, reduction in morbidity/mortality, measurable enhancement of quality of life, and decreases in lengths of hospital stay, perhaps this effort can meet the criteria for excellence in wound care.

I read this month’s CE with great anticipation. I was hoping to discover, at last, specific criteria for “wound care excellence.” In searching the manuscript, I was disheartened. In searching for similar content, I found 2 published articles on related topics.1,2 In these, too, the term excellence was used only in the title and fell short of any discussion about the parameters used to define or measure excellence. It is clear that the term excellence in wound care is often used, but rarely defined.

The term is creeping into other areas of research.2,3 According to some, using the word excellence is “embellishing the actual content of their work.”3–5 A study looking at the United Kingdom’s new higher education white paper found that it uses the word 115 times. The word also appears 13 times in the review of the United Kingdom’s research councils carried out by former Royal Society president Sir Paul Nurse.3,4

The reason for the emergence of the term in academic papers appears to be an institutionalized, ever-increasing need for researchers to demonstrate excellence.3,4 The term lacks specificity in its meaning because academics often struggle with deciding what research is excellent and what is merely good. For example, in 1 study, previously accepted papers were resubmitted to journals in a slightly altered form—and about 90% were rejected; that is to say, they were deemed insufficiently excellent now by journals that had previously decided they were excellent enough to enter the literature. Even if it is meaningless, an endless focus on excellence is far from harmless, according to Prof Martin Paul Eve at the University of London.3,4

Our focus should be on sound experiments that attempt to replicate the findings of previous studies. Research methods should be sound, not excellent. The research community should aim for “appropriate standards of description, evidence, and probity” rather than “flashy claims of superiority.”3,4

This less flashy approach has been incrementally adopted by many journals, including this one. The importance of methodology and reproducibility is the keystone for the peer-review process as promulgated by the Patient-Centered Outcomes Research Institute. During our peer-review process, we emphasize methodology, which should be reproducible and support the conclusions of the study.

Using the search terms excellence and wound centers, a pattern emerged. I could not determine the criteria for excellence as a distinction in the provision of wound care. It appears that excellence, although promising, is not measurable, and we should invest our time and resources using sound methods to collect and analyze both qualitative and quantitative metrics to measure patient outcomes, instead of relying on jargon to make our case.

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References

1. Howell RS, Gorenstein S, Castellano M, et al. Wound care center of excellence: guide to operative technique for chronic wounds. J Am Coll Surg 2018;226(2):e7–17.
2. Pasek TA, Geyser A, Sidoni M, et al. Skin care team in the pediatric intensive care unit: a model for excellence. Crit Care Nurse 2008;28(2):125–35.
3. DaVanzo JE, El-Gamil AM, Dobson A, Sen N. A retrospective comparison of clinical outcomes and Medicare expenditures in skilled nursing facility residents with chronic wounds. Ostomy Wound Manage 2010;56(9):44–54.
4. Matthews D. Focus on research ‘excellence’ is ‘damaging science’. Times Higher Education. 2016. www.timeshighereducation.com/news/focus-on-research-excellence-is-damaging-science#survey-answer. Last accessed March 27, 2018.
5. Moore S, Neylon C, Eve MP, O’Donnell DP, Pattinson D. “Excellence R Us”: university research and the fetishisation of excellence. Palgrave Communications. 2017;3:16105.
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