Editor`s Opinion: Progress: Baby Steps Yield Leaps and Bounds
Clinicians know they must answer 3 questions before implementing any intervention: 1) Can it work? 2) Does it work? 3) Is it worth it?1 Most issues of Ostomy Wound Management contain preclinical and clinical reports that attempt to answer the first of these questions. For the clinician looking for information and guidance in the literature, it may be disheartening to realize a study does not provide solid answers to the second or third question and yield ready-to-use results. In fact, many studies only answer part of the first question using in vivo or in vitro research methodologies — baby steps toward the ultimate goal of implementing care that is efficacious, effective, and cost effective.
However, when that goal has been achieved, progress can be made with lightning speed. To whit: utilizing all available evidence and Medicare payment incentives and the United States Department of Health and Human Services Partnership for Patients initiative led by the Centers for Medicare and Medicaid Services, a variety of measures were implemented to reduce hospital-acquired conditions (HACs), including pressure ulcers.2 Between 18,000 to 33,000 medical records are reviewed annually to track national progress toward reducing adverse events that are considered preventable.3 The news has been very good for patients and the financial bottom line. Preliminary data show the rate of HACs has continued to decline since 2010, with an estimated cumulative total of 800,000 fewer incidents, 50,000 fewer patient deaths secondary to HACs, and $12 billion in health care costs saved from 2010 to 2013.2 The 2 largest contributors to these data were reductions in pressure ulcers and adverse drug events: 20% of the overall 17% reduction in HACs between 2010 and 2013 is due to a reduction in the rate of hospital-acquired pressure ulcers.2 An estimated 20,000 pressure ulcer-related deaths were averted and $4.7 billion saved. In other words, approximately 40% of total savings as a result of reducing the rate of hospital-acquired problems was the result of lower hospital-acquired pressure ulcer rates.
Clearly, patient safety initiatives and payors will continue to scrutinize pressure ulcer prevention efforts and pressure ulcer rates. We also know the nationwide rate of hospital-acquired pressure ulcers is unlikely to reach 0% because not all pressure ulcers are avoidable.4 As such, much remains to be done to understand the approximate rate of unavoidable and avoidable pressure ulcers. How low can/should the numbers go? Ongoing data collection and analysis of hospital-acquired pressure ulcer data may help shed light on that question, as will (hopefully) the work of researchers who continue to help us take the baby steps needed before we can run all avoidable pressure ulcers into the ground.
This article was not subject to the Ostomy Wound Management peer-review process.
References
1. van Rijswijk L, Gray M. Evidence, research, and clinical practice: a patient-centered framework for progress in wound care. Ostomy Wound Manage. 2011;57(9):26–38.
2. Agency for Healthcare Research and Quality. Interim update on 2013 annual hospital-acquired condition rate and estimates of cost savings and deaths averted from 2010 to 2013. Available at: www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2013.pdf. Accessed May 16, 2015.
3. Hackbart AD, Munier WB, Edldrige N, Jordan J, Richards C, Niall B, et al. An overview of measurement activities in the partnership for patients. J Patient Safety. 2014;10(3):125–132.
4. Edsberg LE, Langemo D, Baharestani MM, Posthauer M, Goldberg M. Unavoidable pressure injury: stage of the science and consensus outcomes. J Wound Ostomy Continence Nurs. 2014;41(4):313–334.
