What is the TIME Clinical Decision Support Tool?
The TIME Clinical Decision Support Tool (CDST) is an updated, systematic framework for wound management that addresses tissue management, infection/inflammation control, moisture balance, and epithelial edge advancement, while explicitly incorporating the broader patient context beyond just the wound itself. 1
Background and Evolution
The TIME principle was originally published in 2003 as a framework to guide wound care decisions, but it faced criticism for focusing too narrowly on the wound rather than the holistic patient presentation. 1 In response to these limitations, an expert meeting in London in 2018 elaborated upon and updated this framework into the TIME CDST to address current challenges in wound care delivery. 1
Core Components of TIME CDST
The framework addresses four key wound bed preparation elements:
- T (Tissue Management): Assessment and management of non-viable or deficient tissue in the wound bed 1
- I (Infection/Inflammation Control): Identification and management of infection and inflammatory processes 1
- M (Moisture Balance): Optimization of wound moisture levels to promote healing 1
- E (Epithelial Edge Advancement): Facilitation of epithelialization and wound closure 1
Key Distinguishing Features
The critical advancement of the TIME CDST over the original TIME principle is its explicit integration of patient-centered factors and broader clinical context, moving beyond a purely wound-focused approach. 1 This aligns with contemporary evidence that clinical decision support tools should be patient-specific and incorporate individual patient characteristics, values, and circumstances. 2, 3
Clinical Implementation Benefits
The TIME CDST provides several advantages for wound care delivery:
- Systematic structure: Offers a consistent, evidence-based approach to wound management that has been lacking in clinical practice 1
- Accessibility: Designed as a simple yet robust framework that can be readily integrated into clinical workflows 1
- Improved outcomes: The structured approach is intended to facilitate consistency in wound care delivery and enhance patient outcomes 1
- Organizational benefit: Supports health service organizations by standardizing care processes 1
Implementation Context
The TIME CDST represents a type of clinical decision support system designed to help clinicians with complex decision-making tasks in wound management. 4 Like other effective clinical decision support tools, it aims to provide patient-specific assessments that support clinical decisions and improve adherence to standards of care. 3 The framework's success depends on ease of use for busy clinicians and integration into care processes without disrupting clinical workflow. 3
Common Pitfalls to Avoid
When implementing the TIME CDST, clinicians should be aware that:
- Context matters: While the framework provides structure, it must be applied with consideration of individual patient variation, local resource availability, and clinical expertise 5
- Not purely algorithmic: The tool should guide rather than replace clinical judgment, as good clinical knowledge cannot be mechanically applied to individual patients 5
- Requires active engagement: Like other clinical decision support systems, uptake improves with active education and gradual adoption 3