The Whittington Health (WH) Tissue Viability Service (TVS) aims to:

• provide specialist advice and support to healthcare professionals on the management of patients with, or who are at risk of developing, chronic wounds such as pressure ulcers
• provide advice on the management of patients who have developed leg ulcers and other types of wounds that are difficult to heal
• advise on the appropriate use of advanced wound care technologies
• reduce and prevent secondary care admissions through early intervention and management of infections
• work closely with the multidisciplinary team in the management of diabetic foot patients
• develop information and guidance for health professionals, patients and carers on wound healing and prevention of pressure ulcers.

The TVS does not run any wound clinics. The Haringey service sees ambulant patients at the GP practice with the practice nurse, and housebound patients with the district nursing (DN) teams in patients homes/residential homes.

The TVS visits nursing homes independently as required. There is also a separate specialist leg ulcer clinic (limited numbers) ran by the DN service.

Referrals

Prior to referral to the TVS, it is expected that a holistic and wound assessment are completed and standard care implemented. If the wound does not make the expected progress, then refer following the guidelines below.

Community:

• after four weeks of standard care 
• support with leg ulcer management within the practice setting 
• all patients with category (grade) 3 or 4 or ungradable pressure ulcers.

Hospital:

• non-healing complex wounds 
• acute, traumatic injuries 
• all patients with category (grade) 3 or 4 or ungradable pressure ulcers.

Community waiting times are as follows:

• patients who have category (grade) 3 or 4 or ungradable pressure ulcers will be seen within three working days
• all other referrals will be prioritised and seen within six weeks.

Hospital waiting times are as follows:

• patients will be seen according to clinical need, with the aim to see all appropriate inpatient referrals within 72 hours
• priority will be given to category (grade) 3, 4 or ungradable pressure ulcers.

Eligibility Criteria

Inclusions

Patients aged 18+ who live in or are registered with a GP in Haringey or Islington (including the mental health units), or are housebound within the Haringey/Islington area, may be referred for:

• a wound that shows no signs of healing, is slow to heal or deteriorating
• a wound that has not responded after four weeks of standard care, where the expected/planned outcome is healing
• management of fungating wounds
• all category (grade) 3 and above pressure ulcers or ungradable pressure ulcers
• when compression bandaging or hosiery cannot be tolerated by the patient
• when other advanced wound therapies (e.g. topical negative pressure wound therapy, larvae) haven't worked
• advice regarding pressure-relieving equipment and management to prevent pressure ulcer development.

Exclusions

• patients who have not completed the following community care:
  • four weeks of standard care
  • support with leg ulcer management within the practice setting
  • all patients with category (grade) 3 or 4 or ungradable pressure ulcers.
• if the patient is ambulant and their GP practice is outside of borough, or has a borough GP but is housebound outside of the borough, they should be managed by the local TVS.

How to Refer

Locations

Community Tissue Viability Service

Whittington Hospital Tissue Viability