Cohort study of diagnostic delay in the clinical pathway of patients with chronic wounds in the primary care setting

OBJECTIVES: Exact wound diagnosis is essential for successful wound management and a holistic care of the patient suffering from a wound. Wound management has been traditionally seen as a nursing area, but this can lead to considerable delays in wound diagnostics. A diagnostic delay has been recognised as an element of diagnostic error, which, in turn, affects patient safety. The aim of this cohort study was to examine diagnostic delays of chronic wound within primary care. SETTING: A specialised diagnostic unit, a wound care team, was established in the primary healthcare with the objective of reducing diagnostic and treatment delays in primary care. PARTICIPANTS: The data consists of 197 consecutive patients attending their first appointment with the wound care team in 2016. The collected data included basic demographics, information about the clinical pathway, including doctor’s appointments in primary and specialised care, as well as the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes. PRIMARY AND SECONDARY OUTCOME MEASURES: The diagnostic delays were calculated in days and divided into three groups: (1) patient-related delay, (2) diagnostic delay and (3) organisational delay. RESULTS: The median duration of a patient-related delay was 2 days (IQR 0–14), whereas a physician’s first evaluation was performed at a median of 8 (1–32) days from wound appearance and the correct diagnosis by the wound care team was established in a median of 57 (33–100) days. The organisational delay from first contact to diagnosis was a median of 41 (22–80) days. Only one in three patients had a diagnostic delay of less than 4 weeks. CONCLUSIONS: According to this study, the diagnostic delay occurs within primary care, as an organisational delay from first contact to correct diagnosis. It is possible to arrange an optimal pathway of care in which a holistic wound care process starts within primary care.