A four tiered system model for wound care interventions, based on the complexity of the wounds and a support structure from specialist services, is in place across the Doncaster Wound Care Alliance;
Tier 1 – acute healing wounds, less than 14 days old with healthy granulation/epithelial tissue, managed by the General Practice/ District Nurse / Ward Staff
Tier 2 – chronic healing wounds, more than 14 days old with 50% or more healthy granulation/epithelial tissue, managed by the General Practice/ District Nurse / Ward Staff
Tier 3 – non healing wounds, 50% or more devitalised/slough/necrotic tissue, managed by the General Practice/ District Nurse / Ward Staff AND a specialist service e.g. The Skin Integrity Team, Tissue Viability and Lymphoedema Service, Vascular Service, Podiatry.
Tier 4 – Complex non healing wounds, 50% or more devitalised/slough/necrotic tissue, managed by a specialist service only e.g. The Skin Integrity Team, Tissue Viability and Lymphoedema Service, Vascular Service, Podiatry.
General practices across Doncaster will provide different levels of the tiered system model. For patients registered at a general practice that does not provide required tier for their care a referral will be sent to a wound care alliance hub, which is managed by the Tissue Viability and Lymphoedema Service and/or FCMS Doncaster Urgent Treatment Centre for the care to be provided. The hub may not be located at the registered at a general practice.
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