Reducing hospital acquired pressure injury in a learning health center: Making the case for quality.

Introduction: The purpose of this descriptive study is to examine a learning health system (LHS) continuous improvement and learning approach as a case for increased quality, standardized processes, redesigned workflows, and better resource utilization. Hospital acquired pressure injuries (HAPI) commonly occur in the hospitalized patient and are costly and preventable. This study examines the effect of a LHS approach to reducing HAPI within a large academic medical center. Methods: Our learning health center implemented a 6-year series of iterative improvements that included both process and technology changes, with robust data and analytical reforms. In this descriptive, observational study, we retrospectively examined longitudinal data from April 1, 2018 to March 31, 2022, examining the variables of total number of all-stage HAPI counts and average length of stay (ALOS). We also analyzed patient characteristics observed/expected mortality ratios, as well as total patient days, and the case-mix index to determine whether these factors varied over the study period. We used the Agency for Healthcare Research and Quality cost estimates to identify the estimated financial benefit of HAPI reductions on an annualized basis. Results: HAPI per 1000 patient days for FY 20 (October 1-September 30) and FY 21, decreased from 2.30 to 1.30 and annualized event AHRQ cost estimates for HAPI decreased by $4 786 980 from FY 20 to FY 21. A strong, statistically significant, negative and seemingly counterintuitive correlation was found (r = -.524, P = .003) between HAPI and ALOS. Conclusions: The LHS efforts directed toward HAPI reduction led to sustained improvements during the study period. These results demonstrate the benefits of a holistic approach to quality improvement offered by the LHS model. The LHS model goes beyond a problem-based approach to process improvement. Rather than targeting a specific problem to solve, the LHS system creates structures that yield process improvement benefits over a continued time period.

Cost of Quality Pilot: A Systematic Methodology for Examining the Cost of Pressure Injury.

Health care costs in the United States are considerable, and total national cost of preventable adverse events in the United States ranges from billions to trillions of dollars annually. Achieving the highest quality of health services requires delivering care that mitigates the risk of patient adverse events. Pressure injuries are a significant and costly adverse event. Mitigating or eliminating harm from pressure injuries not only improves quality and increases patient safety but also decreases costs of care. The purpose of this article is to pilot a systematic methodology for examining the differences in the cost of care for a subset of patients with and without hospital-acquired pressure injuries in an acute care setting.

Abdominal Wound Healing Using Negative Pressure Wound Therapy With Instillation and Dwell Time in Critical Care: A Case Study.

INTRODUCTION: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be a viable option in abdominal wound healing protocols. To shed additional light on NPWTi-d, the present case study describes the treatment of a large postsurgical abdominal wound. CASE REPORT: A 50-year-old female with multiple comorbidities underwent complete colectomy, end ileostomy, and percutaneous endoscopic gastronomy tube placement and subsequently developed a 27 cm x 22 cm x 7 cm abdominal wound that was approximately 85% covered by a thick layer of necrotic fat. After multiple surgical debridements over a 4-week timeframe, with recurrent adipose necrosis and failed surgical closure, NPWTi-d was initiated using 50 mL normal saline with 10-minute dwell time followed by 3.5 hours of continuous negative pressure at -125 mm Hg. Perforated foam was used in the wound bed. The NPWT dressings were changed twice weekly, and a physical debriding pad was used during dressing changes as needed. The instillation fluid was changed to an antimicrobial when an infection developed. Over the course of 6 weeks of treatment with NPWTi-d, progressive improvement was noted in wound size and depth; the final wound measurement was 25 cm x 22 cm x 4.5 cm, and 25% of the wound bed was covered with a thinner layer of necrotic tissue. Unfortunately, the patient died due to her underlying illness. CONCLUSIONS: Despite the patient's overall failure to thrive, poor nutrition, and persistent high acuity, this wound improved dramatically with attention to the complexities of stoma care and the use of NPWTi-d.

Innovations in Pressure Injury Reporting: Creating Actionable Data for Improvement.

This department column highlights translation of research into health care quality practice. Achieving the highest quality of health care requires attention to developing and sustaining process efficiencies, and a thorough understanding of data and reporting. Mitigating or eliminating harm from pressure injuries may be more quickly achieved when accurate and consistent data are available for creating actionable interventions. The three aims of this project were to (1) confirm internally reported hospital acquired pressure injury data, (2) identify opportunities for improving the accuracy of internal reports, and (3) design and implement innovative quality informatics solutions for pressure injury reporting.