By Martin Burns
Hospital-acquired conditions— everything from adverse drug events to accidental falls to surgical site infections—have historically been tremendously expensive for patients and hospitals alike. But according to data recently released by the Agency for Healthcare Research and Quality (AHRQ), the overall picture is starting to improve. The new data show a reduction in hospital-acquired conditions of 910,000 (about 13 percent) between 2014 to 2017, which not only helped prevent 20,500 U.S. hospital deaths but also saved $7.7 billion in healthcare costs.
Yet among this positive news regarding the dropping rates of most hospital-acquired conditions, one area, pressure injuries—also known as pressure ulcers and bed sores, and often classified as “never events”—continue to exact an exorbitant cost on the budgets of healthcare providers. The same AHRQ report shows that the rate of pressure injuries actually increased by six percent during the same time period as the rates of other conditions were on the decline.
It is worth taking a somewhat closer look at the continuing financial and reputational toll that current rates of pressure injuries are having on healthcare providers and health systems alike. According to data published in Nursing Economics and other journals, the treatment cost for pressure injuries is 2.5 times the cost of prevention. And U.S. government testimony has suggested that the overall cost to treat pressure injuries in the U.S. in 2017 alone was more than $25 billion.
Prior research published by the AHRQ and the journal Medical Care estimated that pressure injuries involved an annual treatment cost to the U.S. healthcare system of anywhere between $9.1 billion and $11.6 billion. Additionally, the American Journal of Surgery has reported that the average hospital treatment cost associated with the most severe pressure injuries is $129,000. If this in itself weren’t serious enough, the same sources have estimated that the cost of individual patient care for pressure injuries can range from $20,900 to $151,700 per injury, and furthermore that there is an average $43,000 incremental direct cost of a pressure injury during a single hospital admission.
What would be the cost benefit to hospitals stemming from the prevention of pressure ulcers? Research has suggested that prevention of pressure ulcers could have a cost benefit to U.S. hospitals of $7,276 per patient, compared to a treatment cost of $10,053 per patient hospitalization. As things stand today, the median additional length of stay in a U.S. hospital due to a hospital-acquired pressure injury stands at 5.1 days, according to another AHRQ report. Meanwhile, in the United Kingdom, it was estimated in 2004 that up to £2.1 billion was being spent annually on treating pressure ulcers, representing four percent of the total expenditure of the NHS. A more recent study found that the cost of managing wounds in primary care (including pressure injuries) may be as high as £5.1 billion per year.
Litigation is also a significant contributor to the costs of pressure injuries. A recent study suggests that the average settlement of a lawsuit filed in the U.S. as a result of a pressure injury is $250,000, with some awards reaching as high as $312 million; furthermore, plaintiffs are favored in up to 87 percent of these cases. Overall, more than 17,000 lawsuits in the U.S. are filed as a result of pressure injuries every year. This state of affairs is mirrored in the United Kingdom. For example, an analysis of 313 claims received by NHS Resolution between 1995 and 2012, brought on behalf of ICU patients, found that pressure ulcers were not only the most common complaint category but also represented the second most costly condition, with compensation at £4.5 million. Additional recent data from NHS Resolution revealed the cost to the NHS for successful claims in 2017-2018 alone as greater than £20 million, an increase of 53 percent over a three-year period.
Given the fact that the incidence of pressure injuries is increasing, it is crucial that healthcare systems focus on prevention and strive toward reducing the rate of pressure injuries, as data have shown most are avoidable. While this may seem like an overwhelming challenge, new technology that can assess changes in electrical capacitance of tissue can offer support in achieving this goal. Doing so may not only save lives, but may also translate into billions of dollars of savings for healthcare systems in the U.S. and abroad—all while improving quality of life for patients.
Martin Burns is CEO of BBI LLC (Bruin Biometrics), a pioneer in modernizing healthcare with biometric sensor technology for early detection and monitoring of chronic, preventable conditions in collaboration with clinicians.