The development of a Multidisciplinary e-Care Coordination (MDeCC) prototype to facilitate effective care of pressure injuries

Abstract

Background

Pressure injuries (PIs) remain a critical quality and safety concern in healthcare, often resulting from fragmented care coordination and inconsistent adherence to evidence-based practices. They mainly impact immobile patients, especially the elderly, critically ill, or neurologically impaired individuals with extended stays or poor nutrition. Digital health solutions show promise in standardizing and enhancing interdisciplinary care, but many systems do not accurately reflect real-world workflows or frontline clinical needs.

Objective

This study describes the first two phases in the development of the Multidisciplinary e-Care Coordination (MDeCC) system, an evidence-based, co-designed digital care component for PI management focusing on protocol development, stakeholder engagement, and initial digital configuration.

Methods

A qualitative participatory design approach was employed across two phases to co-develop the content and structure of the MDeCC prototype. In Phase 1, three iterative co-design workshops were conducted with clinicians, administrators, and caregivers. These workshops served as qualitative inquiry sessions to explore current workflows, identify challenges, and co-generate design input. A structured PI care protocol was co-created and validated through stakeholder feedback. In Phase 2, the validated protocol was translated into a configurable digital prototype compatible with the hospital’s OASIS system.

Results

The process yielded a tailored MDeCC prototype grounded in seven evidence-based care domains: assessment, nutrition, mobility, pain management, support surfaces, education, and sustainability of care. Design features emphasized multidisciplinary usability, mobile accessibility, role-specific dashboards, and integration with institutional workflows.

Conclusion

The MDeCC has the potential to support wound care teams, hospital policymakers, and quality inspectors in advancing more coordinated, accountable, and sustainable pressure injury care practices. Future phases will assess real-world deployment and impact.

Clinical trial number

Not applicable.

Introduction

Pressure injuries (PIs), also known as bedsores or decubitus ulcers, are localized wounds caused by sustained pressure, shear, or friction over bony prominences, resulting in damage to the skin and underlying tissues [1]. They mainly affect individuals with limited mobility, such as critically ill, elderly, or neurologically impaired patients, especially those with poor nutrition, incontinence, or extended hospital stays. These injuries represent a critical challenge in inpatient care, contributing to increased complications, prolonged hospitalizations, and adverse patient outcomes [2, 3]. Globally, PIs impose a substantial burden, with severe complications such as infections, osteomyelitis, and chronic wounds contributing to an estimated 60,000 annual PI-related deaths [4]. Beyond clinical consequences, PIs strain healthcare systems financially due to elevated treatment costs and extended hospital stays [5].

Despite their prevalence, PI care delivery remains inconsistent across healthcare settings. Variations in adherence to evidence-based practices, compounded by staffing shortages and resource limitations, frequently undermine optimal care [6]. Addressing these challenges necessitates a standardized, multidisciplinary approach to PI management that enhances care coordination and reduces complications [7]. Digital health technologies have the potential to bridge this gap by facilitating real-time data sharing, clinical decision support, and interdisciplinary collaboration [8]. However, many institutions still rely on paper-based systems or poorly integrated electronic platforms, which limits their ability to consistently implement best practices [9]. This underscores the need for digital solutions that are not only evidence-informed but also context-sensitive and designed to align with day-to-day clinical workflows.

To bridge this gap, this study employed a participatory co-design approach involving nurses, physicians, wound care specialists, and allied health professionals to collaboratively develop a multidisciplinary e-Care Coordination (MDeCC) system. Co-design a stakeholder-driven methodology that integrates end-users’ expertise and lived experiences into the design process, ensuring interventions are clinically relevant and aligned with real-world workflows while fostering clinician ownership for sustained adoption [10–13]. Central to this process is the integration of Evidence-Based Practice (EBP), which grounds clinical decisions in the best available evidence to enhance patient care [14]. Embedding EBP within digital systems promotes consistent care coordination and improved outcomes.

The need for MdeCC development was driven by results from a 2023 prospective 4-week pilot cohort study at the facility where this research was conducted, which revealed a significant decline in PI outcomes under standard care protocols. Among the twelve monitored patients, wound healing was assessed using the Pressure Ulcer Scale for Healing (PUSH), a validated composite tool measuring wound size, exudate, and tissue type on a 0 to 17 scale [15, 16]. PUSH scores, recorded weekly to distinguish healing from non-healing ulcers, increased significantly from 7.9 at baseline to 11.2 at the study’s end (p < 0.05, Wilcoxon Signed-Rank Test), indicating worsening. Wound area expanded from 5.6 cm² to 6.8 cm², with tissue quality and exudate levels also deteriorating, resulting in an overall 48.9% decline in healing progress. These results highlight the urgent need for MdeCC development. This study, therefore, aimed to describe the co-design process of the MDeCC system for PI care coordination, identify essential workflow-aligned components, and develop a prototype to support evidence-based, collaborative practice. It aims to provide healthcare providers involved in PI treatment, such as physicians, nurses, wound care specialists, and related professionals, with valuable insights into collaborative care. It is also relevant for hospital policymakers and quality inspectors aiming to improve care quality metrics related to PI management.

Method

This study used a qualitative co-design approach based on participatory action research principles to develop the MDeCC prototype. The objective was to co-design an evidence-based care protocol and identify essential system components to align with clinical workflows and support collaborative, evidence-based practice. The co-design approach is known to foster highly creative thinking, which is associated with increased research and development efforts, ultimately leading to more effective and successful creation results. Van Cauwenbergh et al. [17] argued that involving stakeholders in the design process of healthcare systems, products, and or services improves the accountability of their features, structure, and outcomes. In the current study, in addition to a co-design participatory approach, the process, informed by the framework of Thomas et al. [18], combined literature review with stakeholder workshops that served as qualitative inquiry sessions. These workshops engaged clinicians, administrators, and caregivers to explore current workflows, identify challenge points, and co-generate design input. The resulting protocol was configured for integration into the hospital information system (HIS) to enhance the consistency, coordination, and quality of PI care delivery.

EQUIP framework

This study was conducted under the Evidence-Based QUality Improvement Project (EQUIP), a structured initiative designed to enhance the implementation of EBP and drive reform in clinical guidelines through interdisciplinary collaboration [19–21]. EQUIP empowers nurses to serve as Implementation Lead (IL) nurses, key roles responsible for identifying clinical challenges, facilitating the integration of best practices, and coordinating change efforts across the care continuum. Within this framework, the project aimed to co-design a digital, multidisciplinary care protocol specifically for PI management, with the objective of improving the quality, consistency, and coordination of care delivery.

Study setting

The study was conducted at a 450-bed tertiary government hospital in Saudi Arabia that serves a large and diverse adult population with both acute and chronic conditions. As a major public healthcare facility, the hospital functions as a referral center for complex and high-risk patients, many of whom are admitted with existing PIs or are at increased risk due to clinical compromise. This has highlighted an ongoing concern related to PI management, with frontline care teams repeatedly facing challenges in providing consistent and coordinated PI care. The frequency and severity of these cases emphasize the need for system-level improvements.

Participants

Using purposive sampling, the study recruited individuals with direct or supportive roles in PI care. A total of 12 participants, excluding the research team, were involved in Phase 1. This multidisciplinary group included physicians, nurses, dietitians, physiotherapists, wound care specialists, patient educators, administrative personnel, academic researchers, and family members of patients. Participation was voluntary, consent was obtained, and no financial incentives were provided. Individuals involved in the initial co-design workshop were retained throughout subsequent sessions, with additional participants added as needed to support the diversity of insights. Due to the clinical status of the target population (e.g., patients who were bedridden, comatose, or cognitively impaired), direct patient involvement was not feasible. Instead, family members and patient educators contributed perspectives on care priorities and unmet needs to ensure the patient voice was represented in the design process.

Data collection procedure

The study occurred in two phases (see Fig. 1), moving from qualitative stakeholder engagement to creating a digital prototype. This paper describes the activities conducted during Phase 1 and Phase 2 of the MDeCC development process, including co-design, evidence synthesis, care protocol validation, and initial prototype setup. Phases 3 and 4, which involve digital deployment, training, real-time observation, and iterative design improvements, are planned for future work and will be detailed in later publications.

Fig. 1.

Structured four-phase framework for the development of the MDeCC system. This paper reports findings from Phase 1 (co-design and care protocol development) and Phase 2 (initial digital configuration and prototyping). Phases 3 and 4 will be conducted and evaluated in future work

Phase 1- co-design and care protocol development

Co-design workshops, proven effective in healthcare digitalization [21], served as the cornerstone of data collection. These sessions fostered collaboration among clinicians, administrators, and researchers, with administrators providing critical input on resource allocation and workflow integration [22]. Three iterative workshops (60–90 min each) were conducted:

Step 1 Contextual inquiry

The first co-design session focused on mapping existing PI care workflows to identify inefficiencies and gaps in coordination. This session involved six participants: the Head of the Plastic Surgery Department, one staff nurse, a nursing director, a dietician, a physiotherapist, and an academic researcher. Researchers captured participants’ insights through audio recordings and detailed observation notes, documenting verbal and non-verbal communication, workflow dynamics, and points of consensus. The findings of this step served as the foundational input for developing the care protocol in subsequent workshops.

Step 2: Literature inquiry

The second co-design session involved reviewing literature from October to December 2023. Using PubMed, CINAHL, Scopus, and Google Scholar, the care protocol was developed based on current evidence-based practices. This task, carried out independently by the academic researcher and the IL nurse, focused on three main areas: strategies for preventing and treating pressure injuries, models of multidisciplinary team collaboration, and technology-enabled wound care approaches. Of the 68 sources retrieved, 37 met the inclusion criteria and were thematically synthesized into various protocol care categories. These evidence-based categories represented the key aspects of PI management and directly influenced step 3 of the co-design phase, where participants reviewed and validated them, forming the foundation of the MDeCC care protocol.

Step 3: Review and feedback

Using the evidence-based categories identified in the second co-design session, which were drawn from international best practices in PIs management, stakeholders were invited to a targeted review and feedback workshop based on their alignment with these categories. During the third co-design session, clinical stakeholders, including a physician, a wound care nurse specialist, a dietitian, a physiotherapist, a nursing director, a health educator, a patient care technician, and a patient relative, reviewed and discussed the relevance and feasibility of these categories in their local context. Through this participatory process, the categories were validated, refined, and relevant ones were adapted to reflect specific institutional workflows, team compositions, and resource availability. Clinical stakeholders then collaboratively drafted the care protocol, considering the workflow logic, responsibilities, and accountabilities in their care settings. The outcomes of this step resulted in a paper-based collaborative care protocol, which accordingly laid the groundwork for digital configuration in Phase 2.

Phase 2: Initial configuration

The fourth co-design session aimed to convert the paper-based care protocol into a digital framework compatible with the hospital’s OASIS system, a web-based platform supporting clinical and administrative workflows. Although OASIS includes modules for medical records, patient administration, pharmacy, and labs, its focus has been on documentation rather than structured care protocols. IT specialists and clinicians, many from the third session, collaborated to embed the evidence-based PI care protocol, emphasizing assessment, care pathways, and documentation logic. Key priorities were multidisciplinary usability, role-specific access, and seamless documentation, ensuring evidence-based care integrity. Incorporating this protocol into OASIS marks progress by adding a structured, standardized care process to an otherwise documentation-centric system. This phase resulted in the development of a configurable digital prototype of MDeCC, thereby laying the groundwork for subsequent testing and enhancement.

Data analysis

The four co-design sessions were audio-recorded and transcribed to facilitate inductive analysis. Transcripts underwent iterative thematic analysis [23], with researchers MA and AS conducting multiple rounds of coding to identify key themes and extract insights for MDeCC model development. MA initiated the inductive coding process, organizing data into subcategories that were later grouped into broader thematic categories. Literature-derived findings were similarly subcategorized and aligned with emergent themes to contextualize design processes. ET and AA contributed to finalizing themes and subthemes, ensuring alignment with both workshop insights and evidence-based practices. To enhance validity, the research team engaged in collaborative discussions at every phase, fostering reflexivity and a shared understanding of contextual nuances. Researcher triangulation strengthened reliability, while iterative dialogue within the group minimized interpretive biases.

Findings

A total of 12 participants contributed to this study, including one academic researcher, one general physician, the Head of the Plastic Surgery Department, one staff nurse, a nursing director, a dietician, a physiotherapist, a patient relative, an IT technician, one patient care technician, one medical records officer, and one health educator. The co-design workshop in Phase 1 included four meetings:

• Contextual inquiry: Involved a Head of the Plastic Surgery Department, one staff nurse, a nursing director, a dietician, a physiotherapist, and an academic researcher.

• Literature inquiry: Conducted exclusively by the academic researcher, IL nurse and supporting research staff.

• Review feedback: In addition to participants in the 1st meeting, this meeting involved a health educator, a general physician, a patient care technician, and relatives.

• Initial configuration: The project manager and IT technician joined the workshop to provide technical insights.

This collaborative process aimed to gather diverse expertise to refine the MDeCC system.

Participants’ perspectives on the co-workshop meetings

Participants expressed an overall positive sentiment regarding the workshop meetings. When asked to provide one-word descriptors of their experiences, they offered terms such as “Engaging”, “Creative”, “Satisfying”, “Stimulating”, “Revealing”, “Illuminating” and “informative”.

Contextual inquiry

Through contextual inquiry session with clinical stakeholders, a range of current practices were identified, systemic inefficiencies, and critical challenges in the delivery of PIs care. Participants highlighted several recurring challenges:

• Manual documentation: Reliance on pen-and-paper methods for wound assessments led to inconsistent and delayed data entry.

• Fragmented communication: Clinicians are not interacting with each other and there is minimal interdisciplinary coordination.

• Discharge planning gaps: At-home care instructions were frequently verbal or inconsistently documented, posing a risk for patient non-adherence.

Identified interprofessional domains supporting PIs’ care

The collaborative literature review conducted during the literature query session by the academic researcher and the lead nurse identified seven key evidence-based areas of care related to managing PIs. Thematic synthesis organized findings into seven evidence-informed categories. As shown in Table 1, these categories correspond with the roles of healthcare professionals typically involved in PIs treatment.

Table 1.

Collaborative care domains for PIs management and responsible healthcare professionals

Domain	Description	Responsible healthcare professional(s)
1. Assessment	Systematic skin inspection, risk staging, and documentation to guide care plans.	• Physicians • Bedside nurses • Wound care nurses
2. Nutrition	Ensuring appropriate caloric, protein, and fluid intake for healing and skin integrity.	• Dietitians, • Bedside nurses
3. Mobility	Repositioning, passive/active exercises, and mobility promotion to reduce pressure duration.	• Physiotherapists • Bedside nurses,
4. Pain management	Pharmacologic and non-pharmacologic strategies to manage wound-associated pain.	• Physicians, • Bedside nurses,
5. Support surfaces	Selection and management of mattresses, overlays, and devices to relieve pressure.	• Wound care nurses, • Physiotherapists
6. Education	Educating patients, caregivers, and staff on prevention and self-care practices.	• Nurse educators, • Bedside nurses, • Family members
7. Care sustainability	Long-term continuity planning including discharge coordination and quality follow-up.	• Discharge nurses, • Case managers, • Family/caregivers

Themes and subthemes

Three primary themes and eleven subthemes emerged from the analysis. The first theme relates to the protocol of care for PIs and comprises four subthemes. The second theme focuses on the technical design of the MDeCC, encompassing five subthemes. The third theme addresses future features, including two subthemes. The themes and their corresponding subthemes are outlined below.

Theme 1 PI protocol of care

The healthcare providers participating in the development and evaluation of the MDeCC model have collectively drawn several conclusions regarding the PI care protocol. These findings were based on their active participation in co-design sessions and an extensive review of relevant literature:

1. Standardization of care: The participants emphasized the importance of a standardized PI protocol to ensure consistent, evidence-based care across different hospital units. The protocol must establish clear guidelines for wound assessment, pressure relief measures, and treatment plans, reducing variability in care delivery. As participants reflected:

Implementing a standardized PI protocol will help us all work on the same page. We need clear, evidence-based guidelines for wound assessment and treatment plans to make sure every patient is getting the best possible care, no matter where they are in the hospital. (Participant, 1^st co-design session)

• 2.Outcome-oriented care: The PI protocol must be designed with a strong focus on measurable care outcomes. These included specific targets such as reducing wound size by a certain percentage, preventing infection, and promoting faster wound healing. The protocol also must aim to improve the patient’s overall quality of life by reducing pain, increasing mobility, and shortening hospital stays. As participants stated:

We need to focus on real, measurable outcomes. Setting specific targets, like reducing the wound size or preventing infections, will help us track our progress and ensure we’re truly improving the patient’s quality of life, less pain, better mobility, and shorter hospital stays. (Participant, 1^st co-design session)

• 3.Multidisciplinary collaboration: A key finding from the participants was that successful PI management required a coordinated effort across multiple disciplines. The protocol must ensure that physicians, nurses, wound care specialists, and other allied health professionals work together to deliver comprehensive care. Regular team meetings were held to monitor patient progress and adjust care plans as needed. As participants reported:

We’ve seen that real progress in managing pressure injuries only happens when everyone is on the same page, doctors, nurses, and specialists all need to coordinate regularly. Our meetings to discuss patient progress and update the care plan are critical for ensuring that nothing falls through the cracks. (Participant, 3^rd co-design session)

• 4.Patient and family involvement: The providers recognized the importance of empowering patients and their families with personalized education on wound care. This not only improved patient outcomes but also fostered greater involvement in care decisions post-discharge.

We found that when patients and their families have a clear understanding of the wound care process, not only do the outcomes improve, but they feel more in control of their own recovery. Giving them the right tools and education helps build confidence in continuing care once they leave the hospital. (Participant, 3^rd co-design session)

Theme 2 MDeCC technical design

During the design process of the MDeCC prototype, participants and designers concluded that several critical factors must be incorporated to improve the system’s overall functionality, user experience, and effectiveness in PI management. These conclusions are based on direct insights gathered through the design process:

• i.User-centered design: The participants stressed the importance of involving clinicians, nurses, and wound care specialists throughout the design process. Regular feedback loops were established through workshops and co-design activities, ensuring that the system would meet the practical needs of its end-users. The interface must be intuitive and customizable, allowing different healthcare providers to adapt the system to their specific preferences. This minimized the need for extensive training and reduced user frustration. As participants reflected:

The system should let us work how we’re used to working, whether it’s a nurse or a doctor. The more adaptable the interface, the easier it’ll be to adopt without needing hours of training, especially in time-sensitive environments like wound care. (Participant, 4^th co-design session)

• ii.Interoperability with existing systems: Healthcare providers highlighted the need for the MDeCC system to seamlessly integrate with existing hospital information systems. This integration would prevent duplicate data entry and ensure continuity of care across platforms. As one participant remarked:

It’s essential that this system talks to our existing platforms, nobody has time for double entry, and when systems don’t connect, crucial information can get lost or delayed. We need everything in one place to ensure we’re all on the same page about the patient’s status. (Participant, 4^th co-design session)

• iii.Mobile accessibility: Providers recognized the importance of developing a mobile version of the MDeCC system. This would allow clinicians to document and access wound care information at the patient’s bedside, improving real-time care coordination and workflow.

Having mobile access to the MDeCC system would allow us to update wound care data at the patient’s bedside in real-time, ensuring we’re always working with the most up-to-date information. This would improve our workflow significantly and ensure better care coordination between team members. (Participant, 4^th co-design session)

• iv.Enhanced communication and collaboration: The inclusion of communication tools, such as instant messaging and case updates, was viewed as crucial for facilitating real-time interdisciplinary collaboration. This would ensure that all team members remained updated on treatment plans and progress.

Having real-time communication tools embedded in the MDeCC system would be a game changer. Instant messaging and live updates on case progress would help ensure that everyone involved in the patient’s care stays informed, which is crucial for timely decision-making and coordinated treatment efforts. (Participant, 4^th co-design session)

• v.Security and compliance: Given the sensitivity of patient data, ensuring robust data encryption and compliance with privacy regulations was seen as a critical factor in maintaining patient confidentiality.

It’s absolutely essential that the system ensures strong data encryption. With the sensitive nature of patient data, we can’t afford to take any chances. Ensuring this level of security will help us maintain patient trust and protect confidential information, which is a critical aspect of healthcare delivery today. (Participant, 4^th co-design session)

Theme 3 future features of MDeCC

1. AI integration: A major finding was the value of incorporating artificial intelligence tools, such as AI-powered wound image recognition. These tools could assist in the automatic identification of wound stages, making assessments faster and more accurate.

Imagine a world where AI-powered tools truly empower us to streamline wound assessments. This is especially true for identifying the stages of pressure injuries. With the speed and accuracy of these assessments, we can enhance our ability to make timely and well-informed decisions about patient care…. (Participant, 4th co-design session)

• 2.Data analytics and reporting: It was suggested that the system include robust data analytics capabilities. Providers emphasized the need for real-time tracking of patient outcomes and resource utilization to identify inefficiencies and areas for improvement. Benchmarking against institutional KPIs (key performance indicators) was considered essential for continuous quality improvement.

It would be wonderful if the system could include data analytics features. This addition would provide us with a much clearer understanding of how our resources are being utilized and help us track patient outcomes more effectively. With real-time data at our fingertips, we can catch inefficiencies early on, and benchmarking against institutional KPIs (key performance indicators)will enable us to measure our progress and keep striving for better quality care. (Participant, 4th co-design session)

Key components for MDeCC prototype development

As shown in Fig. 2, the MDeCC system prototype was designed as a centralized, multidisciplinary coordination component intended to integrate seamlessly with hospital systems. Its purpose is to streamline clinical workflows, standardize documentation, enable real-time communication, and support future integration of advanced decision-support tools. Importantly, the prototype was built to reflect the themes and sub-themes identified through qualitative analysis, ensuring that each key component and functional aspect aligns with the insights and priorities established during the co-design process.

Fig. 2.

MDeCC prototype diagram

Discussion

This study presents the outcomes of Phases 1 and 2 of the MDeCC system development, focusing on co-design, evidence synthesis, protocol validation, and the initial configuration of a digital prototype. These foundational phases underscore the value of engaging frontline clinicians, administrators, and patient advocates in shaping a digital solution that aligns with both best practices and the realities of everyday clinical care in PI management.

This study provides insights for healthcare providers, hospital policymakers, and quality inspectors involved in pressure injury care and prevention.

Frontline clinicians, such as physicians, wound care nurses, and interdisciplinary teams, can use the findings to enhance pressure injury interventions by fostering more coordinated and consistent care delivery in complex clinical environments [24]. For policymakers and hospital administrators, the study offers a foundation for integrating validated digital protocols into institutional systems, helping resources be used more efficiently [25]. Meanwhile, quality inspectors gain access to measurable performance indicators like prevalence rates, which can be used to evaluate care effectiveness, monitor compliance, and support ongoing quality improvement efforts [26, 27]. Collectively, these contributions emphasize the importance of a systemic approach that combines clinical practice, governance, and quality oversight to manage pressure injuries.

The study identified major workflow barriers, such as fragmented communication and inconsistent documentation, which affected the development of a standardized, evidence-based care protocol tailored to the OASIS system [14]. Stakeholders described the process as informative and empowering, aligning with findings in the literature that co-design improves system usability and integration with clinical routines [13, 28]. The iterative feedback loop not only refined the protocol but also fostered trust and adaptability, which are essential for long-term sustainability in dynamic healthcare environments [11, 29].

As highlighted in the literature, current clinical guidelines provide evidence-informed recommendations to support decision-making and standardize care; however, their implementation often falls short in practice [30]. Inconsistencies in guideline development and limited contextual adaptation can diminish their effectiveness. Additionally, implementation studies indicate that multicomponent prevention protocols, which include interventions such as education, documentation, risk assessment, and interdisciplinary collaboration, show potential in improving compliance and decreasing pressure injury rates, despite limitations in methodological rigor [31]. Building on these insights, the care protocol developed in this study was derived from rigorously synthesized evidence and tailored to the local context through the input of frontline clinical experts.

Organized into seven key domains, assessment, nutrition, mobility, pain management, support surfaces, education, and care sustainability, this protocol forms the foundation of the MDeCC prototype. Converting these domains into a structured digital format helps address ongoing inconsistencies in pressure injury management [32] and promotes consistent, guideline-aligned practices through interoperable workflows integrated into daily care [33].

Importantly, the digital format supports interdisciplinary coordination by making standardized protocols visible and actionable across professional roles. This functionality addresses a key limitation of traditional paper-based systems, such as isolated decision-making, and promotes collaborative planning among nurses, physicians, allied health professionals, and educators. Literature underscores that such integrated care models enhance communication efficiency and contribute to better wound healing outcomes, especially in complex, resource-limited environments [34]. However, multidisciplinary approaches are not without challenges. Differences in professional cultures, communication styles, and role expectations can sometimes lead to misalignment, resistance to shared decision-making, or workflow inefficiencies if not well-coordinated [35]. Despite these potential drawbacks, the MDeCC system mitigates many of these risks by embedding structured, evidence-based protocols within a shared digital interface that fosters role clarity and synchronized care delivery. Thus, it not only promotes protocol adherence but also operationalizes team-based care as a core mechanism for improving clinical outcomes.

The technical design of the MDeCC prototype embodies principles of user-centered and interoperable system architecture, consistent with best practices in digital health innovation [36]. Prior studies have emphasized that intuitive interfaces, mobile accessibility, and role-specific functionalities are critical to reducing documentation burden and enhancing clinician engagement [37]. The MDeCC system incorporates these design principles to support real-time decision-making, streamline team communication, and improve workflow efficiency.

Looking forward, MDeCC’s architecture is intentionally designed to accommodate AI-powered tools such as wound image recognition and predictive analytics. This forward compatibility reflects trends in digital health innovation, where systems must evolve to handle increasingly complex data and support proactive care planning [38]. Although these AI functionalities are still in future phases, their inclusion in the prototype’s technical structure demonstrates foresight and scalability, qualities highlighted in digital transformation frameworks like HIMSS (Healthcare Information and Management Systems Society) and the WHO’s (World Health Organization) digital health guidelines [39].

Beyond its institutional application, the MDeCC framework presents important policy-level implications. As healthcare systems increasingly pursue digital transformation and care standardization, structured models like MDeCC offer a replicable approach for integrating evidence-based protocols into national health strategies, particularly for high-burden conditions such as pressure injuries. Previous studies have highlighted the importance of system-level digital integration for improving consistency in care delivery and supporting large-scale quality improvement efforts [40]. The MDeCC’s emphasis on interdisciplinary coordination, real-time data capture, and protocol adherence aligns with global recommendations for embedding clinical decision support tools within health IT infrastructures to strengthen clinical governance and promote sustainability [41]. As such, MDeCC contributes not only to localized practice improvement but also to broader digital health policy agendas across similar care systems.

Future direction

While the current study does not include clinical implementation or outcome evaluation of the MDeCC system, it provides a critical foundation for subsequent work. As part of a structured four-phase initiative, this study reports on Phases 1 and 2, which focused on the co-design of an evidence-informed care protocol and the initial development of a digital prototype through stakeholder engagement. Phases 3 and 4, which include full digital deployment, staff training, real-time observation, and iterative refinement, are scheduled for the future implementation. These next phases will be essential for generating empirical evidence on system usability, clinical effectiveness, staff satisfaction, and organizational impact. The project is co-led by an academic researcher and an IL nurse, and supported by a multidisciplinary team with expertise in clinical care, quality improvement, and informatics. Although the work is institution-based, the MDeCC framework is intentionally designed for scalability, with national and international collaboration encouraged to ensure broader relevance, adaptation, and validation across healthcare systems.

Limitations

While the development of the MDeCC prototype marks a meaningful step toward improving PI care, several limitations should be acknowledged. First, the participant sample, comprising healthcare professionals and patient family members, was relatively small and drawn from a single institution. This limits the diversity of perspectives and may restrict the generalizability and transferability of findings to other clinical contexts. Second, it is worth noting that although the sample size was relatively small, the study focused on depth rather than breadth, and data saturation was reached, ensuring that key themes were thoroughly explored and no new insights emerged in later analysis stages. However, as with most qualitative studies, findings are context-specific and may not be generalizable to other settings; therefore, they require further validation across different healthcare environments. Additionally, interpretations may be influenced by the researcher’s subjectivity despite efforts to ensure rigor. Third, this study focused exclusively on Phases 1 and 2, co-design and initial configuration, without evaluating the system’s implementation, usability, or clinical effectiveness in real-world practice. These dimensions will be addressed in subsequent phases. Future research should explore the system’s adaptability, scalability, and long-term adoption across different institutional environments and user populations.

Conclusion

This study developed a prototype of the MDeCC system by translating a validated, evidence-based PI care protocol into a digital format. Through an iterative, user-centered co-design process involving clinicians, administrators, and caregivers, the system was tailored to fit real-world workflows and institutional infrastructure. The resulting prototype promotes standardization, interdisciplinary collaboration, and efficient, patient-centered care. These outcomes are especially important for wound care teams, hospital policymakers, and quality inspectors, key stakeholders who can lead, support, and sustain system-wide improvements in pressure injury care. While implementation and evaluation will follow in future phases, the outcomes of Phases 1 and 2 establish a strong foundation for scalable digital integration and contribute to the advancement of technology-driven quality improvement in PI management.

Abbreviations

PI

Pressure injury

PIs

Pressure injuries

MDeCC

Multidisciplinary e-Care coordination

HIS

Hospital information systems

LIS

Laboratory information systems

EQUIP

Evidence-based quality improvement project

Author contributions

Conceptualization and design, M.O.A and A.Z.S; Data curation, E.S.A, S.A, A.S.A, N.M.A and MRA; Investigation, A.S.A, E.S.A, A.A.A.H, and A.A.A; Methodology, M.O.A, A.Z.S, A.S.A, and E.S.A, M.R.A; Writing original draft, M.O.A; Writing review and editing, A.S.A, E.S.A, A.A.A.H, MM.A, R.A.G, D.J.B, A.M, M.A, S.AL. and S.A; All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Taif University, Saudi Arabia, Project No. (TU-DSPP-2024-282).

Data availability

The author confirms that all data generated or analysed during this study are included in this manuscript.

Declarations

Ethics approval and consent to participate

This study was reviewed and approved by the Scientific Research Ethics Committee at King Faisal Medical Complex in accordance with the applicable regulations issued by the City of King Abdelaziz for Science and Technology, Saudi Arabia: H-02-T-123. Approval number: 2024-E-57. A written informed consent was obtained from all the participants. All authors adhered to the Helsinki Declaration when conducting the research involving human participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.