Wound care delivered in the community consumes substantial healthcare resources (Díaz-Herrera et al., 2025a, Guest et al., 2020, Posnett et al., 2009) and is marked by practice variation (Brabers et al., 2019, Carmichael et al., 2021, Gray et al., 2018) which contributes to delayed healing, inefficient resource use, and significant strain on frontline staff (Skerritt et al., 2025, Stephen-Haynes and Toner, 2025, Gray et al., 2018, Guest et al., 2020, Guest et al., 2015). At the same time, community wound care represents one of the largest yet least optimised segments of municipal health services (Gray et al., 2018, Kapp and Santamaria, 2020). As municipalities face escalating demand and ongoing workforce shortages (Birk HO, 2024, Committee, 2018, Policies., 2023, Posnett et al., 2009, Probst S et al., 2014), wound care stands out as a high-impact area in which simplifying practice and reducing unwarranted variation could meaningfully improve both patient care and operational efficiency (Programme, 2020, Gray et al., 2018).
Chronic, non-healing wounds are, by their very nature, complex, and their development is strongly influenced by underlying aetiologies, contributing to high prevalence rates of pressure ulcers, lower-limb wounds, and diabetic foot ulcers (Probst S et al., 2014, Atkin et al., 2019, Skerritt et al., 2025). Chronic wounds greatly affect patient quality of life (QoL) through pain, exudate, malodour, reduced mobility and social isolation (Atkin et al., 2019, Ousey and Edward, 2014). In Europe, rising healthcare costs have driven a shift from hospital-based wound care to community, home and primary care settings (Probst Set al., 2014). Currently, over 70% of wound-related resources and nursing time are devoted to home or primary care (Díaz-Herrera et al., 2025b, Guest et al., 2015, Guest et al., 2020, Posnett et al., 2009, Gottrup et al., 2013, Skerritt et al., 2025), although wounds managed by specialist hospital teams tend to heal faster (Guest et al., 2020). Fragmentation across providers and inconsistent adherence to best practice guidelines frequently lead to unwarranted variation, clinical uncertainty and inefficient resource use (Marques et al., 2024, Stephen-Haynes and Toner, 2025, Welsh, 2018). Furthermore, community nurses operate under increasing pressure from workforce shortages, rising caseloads and the logistical challenges inherent in providing care in patients’ homes (Genet et al., 2013, Committee, 2018, Analytics, 2021, Witthøft, 2023, Policies., 2023, Research., 2020).
In Denmark, municipalities report similar pressures, characterised by increasing pressure from workforce shortages among nurses and social and healthcare assistants (Analytics, 2021, Witthøft, 2023), high demand for home-based care, and considerable variation in day-to-day practice. Local data suggest that while many community-treated wounds are superficial, complex wounds may consume a significant proportion of nursing time, indicating opportunities for more evidence-based practice (Gottrup et al., 2013). With projected workforce shortages and increasing demand for home-based care, municipalities need practical, scalable solutions that improve efficiency without compromising quality.
The adoption of holistic assessment frameworks, combined with appropriate treatment strategies and carefully selected dressings, has been shown to provide significant clinical and economic benefits, including improved healing rates and reduced costs (Coleman et al., 2017, Young, 2025). Reliance on industry-supported education, endorsed by specialised healthcare professionals (HCPs), has emerged as a response to constrained workforce capacity and documented gaps in wound care competence (Probst et al., 2024). The Wound Care Pathway (WCP) (Caroline Dowsett, 2021) and its implementation in the community setting represent an example of an educational partnership which has supported a shared clinical framework among generalist nurses, improving confidence in dressing selection and consistency in wound management (Jensen et al., 2024).
Through the Coloplast Professional service program, Kalundborg South municipality in Denmark initiated a partnership to evaluate resource use in home-based wound care and to seek support in simplifying treatment practices. As part of this collaboration, the municipality provided access to anonymised wound-related time-registration data covering one full year. The current study therefore aimed to assess wound care related resource utilisation in the home setting in Kalundborg South Municipality and to explore how structured training and simplified treatment approaches could support more value-based practice.
Method
Study design and structure
Anonymized municipal time-registration data from Kalundborg South Municipality, covering 52 consecutive weeks (19 August 2024 – 17 August 2025), were collected. To ensure full anonymity, the municipality randomly selected 80% of citizens who received wound care and/or compression therapy during the study period, yielding weekly totals of time per citizen for wound care and compression. No visit-level timestamps, clinical outcomes or cross-sector linkage data (e.g. hospital care) were available.
Wound events definition
A wound event was defined as a continuous period with registered wound- or compression-care time, ending when there was a pre-specified without registrations. Due to the absence of visit-level detail and the possibility that interruptions in registered care might reflect either true healing or changes in the mode of care delivery (such as hospital admission, self-management or management by other caregivers), two pre-specified event-gap scenarios were applied:
- Scenario 1 (primary): Events ended after one full week with no registered care
- Scenario 2 (sensitivity): Events ended after two full consecutive weeks with no registered care.
Outcomes and analysis
The following were summarised:
- Total nursing hours across activity categories
- Time per event distributions
- The concentration of total wound care time across three event groups: <7 hours, 7 to <30 hours and ≥30 hours per wound event.
Results
Kalundborg data
Overall workload and proportion of wound and compression care
Across 39 activity categories, nurses registered a total of 6,591.5 hours (mean: 126.8 hours/week) over 52 weeks [Figure 1]. The three most resource-demanding activities included wound care (1,996 hours), dispensing medication (1,638 hours) and compression therapy (592 hours), accounting for 30%, 25% and 9% of total nursing time, respectively. Weekly totals ranged from 83.7 to 153.1 hours, indicating a consistently high baseline demand with limited flexibility in capacity.
Event counts, duration and time per event
Under Scenario 1, there were 499 wound events across 3,033 weekly observations (mean duration: 6.1 weeks per event). Under Scenario 2, there were 407 events across 3,382 observations (mean duration: 8.3 weeks per event). In both scenarios, the distributions were right-skewed, with many short-duration events and relatively few prolonged episodes.
Time per wound event
Total time on wound and compression therapy was 2,286.11 hours. With 286 citizens, wound care over a full year would represent a maximum of 14,872 citizen-weeks (286 x 52 weeks). However, only 3,033 citizen-weeks included registered wound/compression care, corresponding to 20.4% of all potential citizens-weeks. This indicates that wound care was not required every week for most citizens and that the majority of citizen-weeks (79.6%) did not include registered wound or compression care. Time per wound event [Figure 2] was also highly skewed and most wound events required two hours or less, while a subset consumed several hours of nursing time.
Concentration of total wound time
Grouping events by total time per event into three categories yielded [Figure 3]:
- <7 hours: 421 events; 28% of total time (642.7 hours)
- 7–<30 hours: 63 events; 36% of total time (831.7 hours)
- ≥30 hours: 15 events (≈3%); 36% of total time (811.7 hours); mean 54.1 hours per event.
Thus, a small number of prolonged events (≥30 hours) accounted for more than a third of total workload.
Discussion
This study provides an overview of time consumption related to wound care activities in a municipal home care setting and highlights important patterns of practice and workflow. Across a full year, wound care and compression therapy accounted for almost 40% of all registered nursing time, consistent with reports from Denmark and the UK, where wound care consistently represents a disproportionate share of nursing workload and healthcare expenditure in the community (Gottrup et al., 2013, Gray et al., 2018, Guest et al., 2020, Maella-Rius et al., 2024, 2014, Guest et al., 2015, Posnett et al., 2009). Furthermore, large variations in time spent (83.7 – 153.1 hours per week) were observed, suggesting limited flexibility within existing capacity. This reinforces the importance of identifying efficiency gains within wound care itself, rather than relying on additional staffing to absorb demand.
Analysis of individual wound events in the current data revealed a highly skewed distribution. Just 3% of wound events accounted for more than one-third of all wound care time, with a mean consumption exceeding 50 hours per event. These long running episodes are likely to reflect complex or hard-to-heal wounds (Skerritt et al., 2025). Conversely, the predominance of short duration wound events highlights an important opportunity to simplify routine wound care, by reducing unnecessary dressing complexity and visit frequency. This may enable a more standardised and structured approach, supporting reduced decision-making demands and practice variation (Gray et al., 2018, Rando et al., 2018, Analytics, 2021, Genet et al., 2013, Policies., 2023). Together, these patterns support a pragmatic service principle: “simplify the many and support the few.” This mirrors NHS community experience, where a minority of complex wounds drive the majority of resource use and where service sustainability depends more on staff capacity than dressing unit price (Díaz-Herrera et al., 2025a, Guest et al., 2015, Gottrup et al., 2013, Posnett et al., 2009).
Evidence consistently indicates that structured, standardised wound care pathways enhance clinical consistency and support more efficient resource use (Programme, 2020, Probst S et al., 2014). Central components include holistic assessment frameworks (Caroline Dowsett, 2017) combined with clear guidance on treatment strategy and dressing selection aligned to clinical needs rather than habit ((WUWHS), 2016). Qualitative data from 261 HCPs highlight structured education, standardised recommendations, improved product knowledge and clearer patient information as key facilitators of patient-centred wound management (Kuhnke et al., 2019). These integrated methods have been demonstrated to deliver significant clinical and economic benefits, offering improved healing rates and reduced costs, largely driven by reductions in dressing-change frequency and unwarranted variation (Coleman et al., 2017, Young, 2025, Öien et al., 2016). Shared-care models represent a complementary approach to community wound care by supporting appropriate patient and carer involvement, with potential to reduce reliance on routine nurse visits and to release capacity for more complex care needs (McDonald, 2020).
Partnership‑enabled training and everyday practice
Within this context, partnership-enabled training initiatives may play a supportive role in addressing known gaps in wound care education among generalist community nurses. Workforce constraints and limited access to specialist training have increasingly prompted collaboration between municipal services and external partners to support competence development (Becker et al., 2025, Anderson et al., 2021, MacLean et al., 2025). The WCP, for example, was an international consensus project involving more than 2,200 HCPs across more than 60 countries, developed to address the lack of structured wound education for non-specialists. This initiative explicitly acknowledges the role of industry-supported dissemination platforms, while maintaining clinician-led content and independence (Caroline Dowsett, 2023). Despite ongoing ethical considerations surrounding public–private collaboration in wound care (Welsh, 2018), such initiatives have been reported to increase knowledge and confidence among generalist nurses and to reduce unwarranted variation in day-to-day practice (Jensen et al., 2024, Probst S et al., 2014, Welsh, 2018), [Box 1].
One of the key aspects of the training sessions was, alongside reinforcing a holistic wound assessment and care approach (Caroline Dowsett, 2017), to promote simplification of wound management by reducing the use of multiple or unnecessary dressings where appropriate. The introduction of a simplified foam-based dressing strategy, using Biatain® foam with 3DFit Technology, was intended to support more consistent first-line management of the large proportion of shallow wounds (≤2cm), which are estimated to represent approximately 80% of wounds (Ousey, 2013). For these wounds, a single-dressing approach without fillers may be sufficient (Braunwarth H, 2018), potentially reducing dressing changes, visit frequency and cumulative time spent per wound. This may allow clinical resources to be redirected toward the smaller subset of complex wounds requiring more intensive assessment and specialist input (Gray et al., 2018).
In addition, the combination of an absorbent foam structure and a fluid lock layer in Biatain® Silicone (standard) provide a visual change indicator which support dressing changes based on clinical need rather than routine. In practice, this validated, visual change indicator acts as a practical tool, signalling when the dressing is approaching its absorption capacity [Figure 4], reinforcing confidence in leaving the dressing undisturbed up to seven days, as indicated in the instructions for use (Coloplast, 2021). Maintaining an undisturbed environment is recognized as beneficial for healing, whereas repeated disturbance may traumatise the tissue and disrupt the wound environment (Berg, 2019, McNab, 2023, Rippon et al., 2012, Rippon, 2015).
From a health-economic perspective, each change involves staff time, supplies and organisational coordination, making dressing-change frequency a key factor in wound-related resource use (Posnett et al. 2009; Öien, Forssell, and Ragnarson Tennvall 2016). A clinical interpretation of the NHS Clinical Evaluation Team Foam Dressings report indicated that premature or routine dressing changes may compromise foam dressing performance and limit efficiency gains (McNab, 2023). In this context, features such as 3DFit Technology and visual change indicators may support simplified dressing strategies and extended wear time, with potential implications for visit frequency, nursing workload and resource utilisation (Nielsen, 2019, Voegeli et al., 2024).
In Kalundborg, even modest extensions in wear time and reduced adjunct product use – if achieved safely through training, pathway adherence and appropriate dressing selection – could translate into fewer changes and lower consumption, potentially releasing capacity without altering service intensity. Reducing decision-making demands and freeing up time allows nurses to focus more attention on the smaller number of complex cases that drive overall workload (Skerritt, Gooney & Sheahan, 2025; Öien et al., 2016).
Taken together, these examples illustrate how structured collaboration through the Coloplast Professional service program may support alignment of wound care practices and create opportunities for more efficient use of nursing time and wound care products in municipal home-care settings. Although derived from Danish municipal data, the workload patterns, variation and capacity challenges described here are highly consistent with those reported across NHS community services, supporting the relevance of these findings for UK wound care practice and service development (Anderson et al., 2021, Gray et al., 2018, Guest et al., 2015, Stephen-Haynes and Toner, 2025).
Strengths and limitations
A key strength of this study is the use of real-world time registration data collected over a full year, providing a comprehensive picture of wound care workload in a municipal setting. However, the study is limited by its observational design and by the absence of direct clinical outcome measures, such as healing rates or recurrence. Data were drawn from a single municipality, which may limit generalisability, although the observed patterns are consistent with findings from other community settings (Gottrup et al., 2013). Additionally, the absence of cross-sector linkage precludes interpretation of the high proportion of citizen-weeks without registered home-care wound time, which may reflect self-care, hospital care or even healing.
Conclusion
The study provides a practical baseline for municipalities seeking to understand and optimise wound care workload. The findings support continued emphasis on standardised assessment, targeted training for generalist staff and simplification of treatment pathways as potentially high-value strategies in community wound care. The Coloplast Professional service program, which fosters collaboration between municipalities and industry, offers significant value by addressing workforce constraints through targeted and evidence-based training for the generalist workforce. These partnership initiatives not only enhance clinical competence but also create an opportunity to reclaim valuable resources for the community by improving efficiency and reducing unnecessary workload. Future evaluations linking time-registration data with clinical outcomes and prospective implementation studies will be important to quantify the impact of such approaches on healing, visit frequency and costs.
Acknowledgement: The authors would like to acknowledge the municipality of Kalundborg for their participation in the Coloplast Professional service program and for sharing their practical experience and reflections on this collaborative approach to community wound care. In addition, the authors acknowledge Eva Egeskov Bach for her valuable contributions to scientific discussion and interpretation of the findings.
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