Reducing Duplication in Wound Care: When Process Creates Harm

Discharge is often treated as the finish line.

For many people with complex wounds, it’s where continuity quietly breaks down.

On paper, the system appears coordinated. A referral is placed. Community services are notified. Follow-up is planned. In reality, the processes designed to ensure continuity can introduce delays that quietly widen risk.

I’ve cared for people whose wounds were clinically straightforward, but whose lives made healing almost impossible. People without a fixed address. People living in shelters or encampments. People discharged from hospital with instructions that assumed a fridge, running water, storage space, transportation, and a phone number that would be answered.

As a nurse, I can assess, debride, and plan. But too often, I find myself navigating systems that were never designed for the realities my patients are living in.

This is especially visible at the point of discharge.

When a referral is placed for a community wound specialist nurse to see a patient after hospital discharge, timelines are not always as immediate as clinicians — or patients — expect. Once a referral is accepted and assigned through the service provider organizer, community wound specialist nurses have up to 14 days to complete the first visit. In practice, this can result in a delay of two to three weeks from the day a patient leaves hospital to the day wound care resumes.

Now imagine that delay applied to a neuropathic foot ulcer. No offloading. No reassessment. No intervention — for three weeks.

This is not a failure of clinical knowledge. It is not missed follow-up. It is a predictable outcome of a process that unintentionally prioritizes administrative sequence over real timelines.

Wounds do not pause while systems align. Tissue breaks down. Infection risk rises. Pressure continues. What begins as a preventable delay can escalate into deterioration, readmission, sepsis, or amputation — outcomes that feel tragic, but are often entirely avoidable.

These gaps are not created by individual clinicians or organizations acting in bad faith. They emerge when systems require multiple reassessments, duplicated approvals, and sequential handoffs — even when everyone involved shares the same goal.

Reducing duplication in wound care is not about rushing care or cutting corners. It is about recognizing where process itself becomes a barrier, and where better connection could prevent harm before it occurs.

Sometimes the most important intervention isn’t a new treatment — it’s creating the conditions for care to arrive in time.

This post reflects professional observations shared for educational and quality-improvement purposes.