Wounds impose a substantial economic burden on healthcare systems [1,2] and have a significant impact on patients’ quality of life. Vital to reducing the costs associated with wound care is identification and treatment of hard-to-heal wounds. Failure to recognise when a wound is not progressing to healing increases the cost of treatment and risk of complications, is more challenging for clinicians and significantly impacts patient quality of life. A recent evaluation of the impact of PICO™ using a defined pathway showed the importance of early intervention in hard-to-heal wounds and the role of advanced therapies in progressing a wound towards healing. Implementing the PICO pathway resulted in statistically significant improvements in the healing trajectory of stalled wounds, both during and after use. It resulted in a 33.1% (£50,000) cost reduction and released 119 days of nursing time over 26 weeks in the treatment of 52 patients.