Pressure ulcers – also called pressure injuries – cause millions of hospitalizations and health...
The Real Cost of Hospital-Acquired Pressure Ulcers (to Facilities and Patients)
The cost of hospital-acquired pressure ulcers is staggering. Due to under-reporting, determining the exact cost of this condition is difficult, but one thing is clear. These injuries cost healthcare facilities millions of dollars a year, and they’re largely preventable.
Any kind of hospital-acquired injury is expensive. When you add up a longer stay in the hospital, the need to administer extra treatments, and the additional time spent in treatment, the costs can grow quickly.
That’s why, across the board, care facilities try to minimize the number of hospital-acquired injuries as much as possible. Despite this, the number and cost of hospital-acquired pressure injuries (HAPIs) has stayed more or less constant.
Why are pressure injuries still so common even though they are preventable? And what is the real cost of hospital-acquired pressure ulcers? Today we will talk about why pressure injuries occur in hospitals, the true cost incurred, and how hospitals can protect themselves.
The cost of hospital-acquired pressure ulcers - by the numbers
Pressure ulcers – also called pressure injuries or bed sores – are painful wounds caused in patients with limited mobility. They occur when a small area of tissue bears the majority of a person’s weight for a long period of time, usually near a bone or joint. When the skin can’t handle the amount of pressure and/or friction, a sore appears.
The cost of hospital-acquired pressure ulcers varies depending on the stage. Pressure ulcers can range from stage 1 to stage 4. In stage one, the patient may experience redness, pain, itching, and/or a hard lump. Stage one pressure ulcers can occur in as little as 4 hours and usually heal within 2 to 3 days.
Stage 4 pressure ulcers are the most serious. At this point, the sore is an open wound, reaching deep into the muscles and other tissues. It is also at high risk for infection. These kinds of injuries develop over a period of several days and can take weeks or months to heal - if they heal at all
Now, let’s dive into some more specific information on hospital-acquired pressure ulcers statistics. This will provide a clearer picture of what this common (and preventable) condition could cost your facility.
How frequently do hospital-acquired pressure ulcers occur?
Looking at current hospital-acquired pressure ulcers statistics, there are more than 2.5 million cases each year, with as many as 60,000 of these resulting in a patient’s death.
More specific information varies significantly from one hospital to another. Orthopedic surgery wards generally have the highest rate of pressure ulcer occurrence, with 18% of patients developing an ulcer during their stay.
Even hospitals with “low” rates of pressure ulcers generally sit at about 4%.
Current pressure ulcer guidelines from U.S. Centers for Medicare and Medicaid Services classify pressure ulcers as a “never” event. This means that hospitals will not be reimbursed for the cost of care surrounding these injuries.
This means that even at the comparatively low 4% rate, the cost of hospital-acquired pressure ulcers falls on hospitals and patients. Should any of these ulcers advance to stage 3 or 4, the cost of hospital-acquired pressure ulcers can easily climb into thousands of dollars per patient.
How much does the average pressure ulcer cost to treat?
There are three determining factors in the cost of care for a pressure ulcer: the severity of the wound, the length of a patient’s stay in the hospital, and any complications related to the ulcer.
In mild, stage 1 cases, pressure ulcer treatment costs roughly $418 per patient. As you get into other stages, the cost jumps rapidly, with a stage 2 ulcer costing around $3,674 per patient and stage 3 estimated at $8,741.
Pressure ulcer treatment for stage 4 ulcers can cost an astonishing $44,000 per patient since these wounds require intensive care and may need surgical intervention.
One reason for the rise in costs is the length of the patient’s stay. The bulk of the cost of hospital-acquired pressure ulcers is primarily found in longer stays. Stage 1 ulcers may require an extra day, but can generally be cared for in the patient’s home.
Meanwhile, stage 2 ulcers extend a patient’s stay by up to 4 days. In stages 3 and 4, this jumps to 2 weeks or longer if any complications arise.
The main complications of pressure ulcers are severe infections. These include sepsis, cellulitis, abscesses, bone or joint infections, and – in severe cases – carcinomas. These increase the cost of hospital-acquired pressure ulcers by requiring additional treatment and longer stays.
Are pressure ulcers preventable?
Whether pressure ulcers are preventable is a topic of some discussion, particularly as research goes deeper.
Some research has suggested that pressure ulcers form at the cellular level, making prevention difficult and taking some of the blame away from hospitals. However, this applies mainly to early-stage pressure ulcers, particularly the ones that seem to form in mere hours.
Even if this is the case, pressure ulcers are preventable as much as 95% of the time. Late-stage pressure ulcers, where the ulcer eats away the top layer of skin and begins to damage muscles, are preventable in every case.
This means that, at a minimum, the largest cost of hospital-acquired pressure ulcers is preventable. This makes the monetary shell-out even harder to stomach. Of course, the monetary costs are not the only cost of hospital-acquired pressure ulcers.
The intangible cost of hospital-acquired pressure ulcers
The largest costs of hospital-acquired pressure injuries are some of the most difficult to measure, as they are largely intangible. These are social and emotional costs that affect both the hospital and the patient severely.
Pressure ulcers all too often fall off the care team’s radar among all the other tasks they need to do to care for patients. For patients and their families, however, the development of a pressure ulcer will remain front-of-mind.
The effect of HAPIs on a hospital’s reputation
When a patient suffers a hospital-acquired infection or injury, this has an effect on the hospital’s standing in the community. This is particularly true in small town communities, where word travels quickly.
When the knowledge spreads that inpatients at a particular hospital frequently have bedsores, it can make both current and potential patients uneasy. This may lead to patients traveling to other hospitals or attempting to care for themselves.
In patients with limited mobility, this increases their risk of developing severe pressure ulcers at home. This later increases their cost of treatment – both for the condition causing the mobility issues, and for treating the ulcer itself.
The cost of hospital-acquired pressure ulcers in terms of reputation is difficult to quantify. Hospital-acquired pressure ulcers statistics show that 9 in 10 people consider the hospital’s reputation important when making healthcare choices overall - so the cost could be monumental.
The cost of HAPIs for the patient
Even if your care facility is the only one in town, the cost of hospital-acquired pressure ulcers for the patient is severe. Aside from impacting a patient’s quality of life and causing vulnerability to infection, HAPIs damage the patient’s trust in their care team.
This can lead to patients withholding information, being reluctant to comply with instructions, and in some cases, actively fighting their care team.
Patients may take action against hospitals where they developed an ulcer, resulting in another cost of hospital-acquired pressure ulcers.
Up to 17,000 legal claims are made against hospitals due to pressure ulcers each year – more than falls and emotional distress, and second only to wrongful death.
On average, these cases are settled in favor of the patient for $200,000. These legal cases further damage a hospital’s reputation and the patient’s trust in their care team, as well as opening the door to further malpractice lawsuits.
How hospitals can protect themselves
With all this in mind, what can hospitals do to protect themselves, their staff, and their patients?
When making a plan for how to prevent bed sores, the entire hospital staff has a role to play. The key to effectively preventing these injuries is creating safeguards at every level of care.
The nurses’ role in pressure ulcer prevention
Nurses have more touchpoints with patients than any other member of the care team. As a result, the nurses’ role in pressure ulcer prevention is greater than most. To prevent pressure ulcers from forming, nurses should:
- Check patients for factors that increase their risk of developing an ulcer
- Turn the patients every 2 - 6 hours, depending on their risk factors
- Use barrier creams to manage moisture
- Keep patients well-hydrated
- Ensure patients have good nutrition
The doctors’ role in pressure ulcer prevention
Doctors can help to prevent pressure ulcers by, first and foremost, educating patients and encouraging them to speak up about any soreness, itchiness, or pressure.
Doctors can also select dressings with collagen in them for more advanced cases. Collagen wound healing is significantly faster than wound healing, without making this a helpful piece of a patient’s care plan.
Prior to the formation of an ulcer, doctors can also ensure the patient is on a highly nutritious diet. This may include oral supplements in patients who struggle to eat a varied diet.
How does nutrition affect pressure ulcers? Pressure ulcers are primarily caused by a patient’s tissue being unable to cope with the amount of stress it is under. Proper nutrition can help strengthen the tissue, and therefore decrease the frequency of pressure ulcers.
One of the simplest ways to protect a patient’s skin through nutrition is with a collagen supplement. While you might shy away from the cost of giving out daily supplements to patients, the cost of hospital-acquired pressure ulcers is significantly higher than the cost of any supplement.
The administrative team’s role in pressure ulcer prevention
The administrative team may not have many touchpoints with the average patient, but they still play a role in care. Since part of their job is to analyze and reduce the cost of care, an administrative team is in the perfect position to lower the cost of hospital-acquired pressure ulcers.
Specifically, they’re perfectly positioned to provide access to equipment that lessens the risk of pressure ulcers. This equipment may include:
- Beds with better ventilation
- Devices that help move a patient more quickly and safely
- Props to help patients rest in less stressful positions
Admin teams can also work with doctors to ensure that patients have access to better nutrition during their stay.
Many administrative teams are reluctant to provide room in the budget for these devices. However, stage 3 and 4 HAPIs account for 58% of annual costs, despite being considered a rare outcome.
Even if better equipment and nutrition reduce the instances of these late stage ulcers, the return on investment is significant.
Make hospital-acquired pressure injuries a true “never” event
Both insurance companies and care teams should consider hospital-acquired pressure ulcers a “never” event – something that should happen under no circumstances.
While care for patients with limited mobility is complex, and we still have much to learn about these injuries, there are a few things that will help mitigate the risk.
First and foremost in prevention is good nutrition, focused on caring for the skin and muscle tissue. Medical-grade collagen products can help with this, especially when taken well before a pressure ulcer begins to form.
Secondly, prioritize the prevention of pressure ulcers across the whole care team. Administrative staff can be trained on the cost of hospital-acquired pressure ulcers and begin looking for high-level prevention tactics.
Doctors and nurses can be trained on how to prevent pressure ulcers at the patient level, and patients themselves can be educated on when to speak up and how they can help themselves, where applicable.
With teamwork and dedication, this preventable condition can be completely eradicated, saving hospitals money and increasing patients’ quality of life and trust in their caregivers.