Trends in Pressure Injury Prevalence Rates and Average Days to Healing Associated With Adoption of a Comprehensive Wound Care Program and Technology in Skilled Nursing Facilities in the United States

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PIs are a major acquired complication across clinical settings. They are defined as "the localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. It can present as intact skin or an open ulcer and may be painful."¹ This prevalent health condition is estimated to affect 1.3 million to 3 million adults in the United States annually.² The prevalence of PI has been worsened by the extraordinary circumstances of the COVID-19 pandemic; CMS reported a 41.8% increase in PI rates in 2020 in SNFs.³ PIs cause sustained physical and mental pain and dramatically decrease patient quality of life, and management of PIs is associated with a significant financial burden to health care organizations.⁴

Ulcers can incur significant costs in the US health care system. Depending on the stage of the ulcer, the cost of treatment can range from $500 to $70 000,⁵ with at least 3.6% of the annual health care setting budget being allocated to this expense.⁵ A 2019 simulation modelling study projected that hospital-acquired PI costs could exceed $26.8 billion annually in the United States.⁶

The expenses are attributed to direct costs, such as extended healing time and additional bed days, as well as medications, dressings, nursing time, special beds and mattresses, surgical management and debridement, radiology and laboratory tests, and increased readmission rate. An observational study conducted in tertiary-care referral and teaching hospitals in Australia reported that PIs extended hospital stay by a median of 4.31 extra days per ulcer.⁷ Moreover, a simulation modeling study conducted using the Markov model estimated the cost of PI to be $893 for stage 1 injury, $3560 for stage 2 injury, $2995 for uncomplicated stage 3 or 4 injury, and $3260 for stage 3 or 4 injury if a complication is identified.⁶

Additionally, there is the indirect cost associated with patient-initiated litigation. In the United States, patient PI litigation suits are the second most common complaint in courts against health care organizations.^8,9

Despite the tangible burden of PIs, no standard healing time has been reported, with most such information limited to stage 2 PIs.¹⁰ A retrospective chart review of data on 1241 stage 2 PIs in 774 residents in SNFs in the United States reported a healing rate of 45.4% within 1 year, with a median time to healing of 46 days.¹¹ Another secondary analysis study collected double-blind, randomized controlled trial data from hospitals, long-term care facilities, and home health agencies to evaluate the healing time of 270 stage 2 PIs.¹⁰ Those authors reported a healing rate of 56.7% and an average time to healing of 23 days. The limited knowledge and variability in documented healing time of different PI stages make it challenging to predict the necessary resources, estimate the exact cost of specialized care and of creating a management plan, and inform patients and caregivers of the duration of treatment and length of stay.¹⁰

Research suggests that PIs are preventable.¹² In fact, the statement that concludes that 95% of PIs are avoidable has been cited in various literature.^13-15 In long-term care organizations CMS considers PIs a quality-of-care measure, whereas in hospitals CMS excludes hospital-acquired PIs from reimbursement services.¹⁶

To address the issue of PIs and the associated costs, many health service organizations have begun implementing standardized, evidence-based PI best practices.¹⁷ While advancements have been made in wound treatment protocols, medication regimens, and tissue regeneration processes, effective wound care and healing rely heavily on timely, accurate wound assessment and tissue identification.¹⁸ Manual wound assessment methods are highly subjective, however, and often result in significant measurement variability¹⁹ and poor clinician agreement concerning epithelial and slough tissue identification.¹⁸ This can result in strenuous, inaccurate, and time-consuming wound management processes.²⁰

In an effort to achieve accurate measurements, improved tissue segmentation, and better wound monitoring, many organizations have adopted digital wound management technology to enhance capacity and advance quality of care. By using modern wound care solutions, which leverage advanced machine visioning and AI technology, health care organizations have been better able to implement wound care programs and deliver improved patient outcomes, such as faster healing and reduced prevalence of PI. Along with these quality improvements, cost drivers associated with PIs can also be substantially moderated.²¹

Many SNFs across the United States are beginning to adopt a more holistic approach to wound management using the Swift Skin and Wound Solution (Swift Medical Inc.) as the DWMS, an AI application for smart devices, as the foundation for a patient-centered team approach. These SNFs have integrated this application with the PointClickCare electronic health record system (PointClickCare) to replace traditional paper-ruler methods in wound assessments at many of their facilities. The DWMS is a digital noninvasive wound assessment application designed to capture high-precision wound images, measurements, clinical characteristics, and documentation to support enhanced management and prevention of wounds.

This cutting-edge DWMS uses advanced clinical algorithms and deep space machine visioning technology originally developed for the Mars Rover. The proprietary technology captures high-precision images and data. The software is equipped with HealX (Swift Medical, Inc.), a US Food and Drug Administration-approved, precision-manufactured design element that enables the application to calibrate wound photographs for color, lighting, and size in real time on smart devices. The AI-powered DWMS independently identifies wound boundaries, measures the wound in 3 dimensions, and identifies tissue types using deep learning and vision architectures designed for smart devices. DWMS has evolved into one of the most comprehensive wound image data sets, comprising over 20 million diverse wound assessments.

The current study evaluated the effect of utilizing technology for wound care management as part of a comprehensive wound care model in a cohort of SNF facilities. The authors studied 128 SNFs that implemented the integrated model. Data from 2021 and 2022 were evaluated to assess changes in PI prevalence rates, average days to healing, potential savings of clinicians' time managing PI and applying dressings, and projected savings of out-of-pocket expenses associated with the decreased prevalence of stage 3 and 4 PI.

The current study also compared the rate of high-level citations associated with PIs (ie, F686 citations) across all 167 facilities that adopted the technology compared with the 181 facilities that did not adopt it. Additionally, the authors compared the rate of cumulative citations received in the 6-year span of 2017 through 2022 (2017-2022) in facilities that had adopted the technology vs those that had not.

It is important to note that these citations, or F-tags, are issued by CMS when an SNF does not meet the federal guideline. These tags have different levels of severity and associated fines. The highest severity level tags are represented by the top-level tags G, J, K, and L. These tags are considered to be the worst. The F686 F-tag may be cited when an avoidable PI develops or worsens and if the clinician does not execute preventive strategies for at-risk patients to avoid a PI incidence.²²

Study design and data sources

This retrospective study used the Swift Medical database (hereafter digital solution database) to access anonymous PI data that were collected by clinicians at participating facilities in the course of completing standard patient wound assessments and evaluations.

The digital solution database is designed to extract anonymous evaluation data from the application to create an extensive systematic and secure collection of wound data sets for exploration and analysis. With every first wound evaluation, the digital solution automatically creates a unique encoded number for the patient. The anonymous wound evaluation data are stored in the database using this coded number. The data set does not involve intervention or affect the care provided, and direct patient identifiers are extracted from the application or accessed from the digital solution analytic database.

All communication with the server follows the Advanced Encryption Standard. The secure database complies with privacy standards under the Personal Information Protection and Electronic Documents Act, the Personal Health Information Protection Act, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The digital solution data engineers' team routinely maintains the anonymous analytic database. The benefits evaluation team has clearance for secure administrative access to the anonymous database.

Clinical and administrative data include patient age and sex. Wound type, wound class, wound temperature, wound age, wound anatomic location, wound healing progress, status of the wound on admission, date of each evaluation, and corresponding facility and organization are also included, as are wound width, length, and depth, and recorded wound surface area.

This descriptive quality improvement study was granted an exemption of ethics review from Pearl IRB, LLC, an independent institutional review board (ID:2023-0100).

Data abstraction and sample

The target population included all patients with PI (all stages) at the SNFs that adopted the DWMS as part of the comprehensive wound care program during the study period (January 1, 2021, through August 31, 2022). The wound evaluation data for all patients at the participating facilities in the study period were accessed from the digital solution database during the first week of September 2022. The database included a total of 106 089 wound patients from facilities that adopted the digital solution in 2021 and 2022. The overall number of PI patients admitted to participating facilities in the study periods were as follows: 15 583 (Jan-Aug 2021) and 30 657 (Jan-Aug 2022).

In general, to be eligible for inclusion in the study a patient's wound evaluation data must have fulfilled the following criteria: (1) any stage PI identified on admission or from either short- or long-term stay residents according to the NPIAP; (2) PI must have been assessed using the technology at the participating facilities and included in the database during the study period, and (3) PI evaluation data included in the comparison analysis collected between January 1, 2021, and August 31, 2021 (2021 data) or between January 1, 2022, and August 31, 2022 (2022 data).

Wound evaluations for etiologies other than PI were filtered out and excluded from the analysis. Additionally, any PI not assessed with the DWMS or that did not have an identified stage was not included in the study. A total of 6045 patients with PI in 2021 (January-August) and 7876 in 2022 (January-August) were included in the analysis.

Data indicators

Point prevalence. The point prevalence rate of PIs was calculated according to Baharestani et al (2009) defintion.²³ The rate was calculated by dividing the total number of patients with any stage PI during the study period (numerator) by the total number of patients admitted to all participating facilities during that time (denominator).

To accurately calculate the prevalence rates of PIs in health care settings, the total number of patients admitted to each participating facility during the specified study period was obtained from the facilities included in the study. This number served as the denominator in the calculation of the point prevalence rate.

PI days to healing. The following indicators were used in the analysis of average days to healing of a PI: PI first and last date of evaluation, wound class (stage), anatomic site, wound healing progress (healed, improved, worsened), and wound status on admission (facility-acquired or not); organization and facility; and patient characteristics on admission (eg, age, sex). Average days to healing was calculated based on the time interval between the first assessment and last assessment date for wounds with an outcome marked "healed."

PI citations (F686). The participating organization provided anonymous, aggregated data on the number of PI citations (F686) reported at each facility that adopted the digital solution, along with comparable data from a control group of facilities that adopted the care model but had yet to adopt the technology. This allowed for a comparison analysis between facilities that had adopted the technology and those that had not, at different points in years 2017 through 2022.

Statistical analysis

Data were analyzed using SPSS version 28 (IBM Corporation). A descriptive analysis was generated from the patient and PI characteristics variables: numeric (age) and categorical (sex, PI stage, anatomic location). Point prevalence rates of PIs for each stage per year were also calculated and expressed as a percentage. Subgroups were created for only the facilities that adopted the system for more than 1 year and inclusive of the full study period in 2021 and 2022, and point prevalence rates were calculated for patients with PI at these facilities. The proportion of F686 citations reported at all facilities (those that adopted the technology and those that did not) for the 6-year period 2017-2022 was calculated. Overall, the findings were summarized as frequencies and as mean ± standard deviation.

Bivariate analyses were conducted. A sample t test was used to examine whether there was a mean difference in average days to healing of PI across each stage of the assessment year (2022 vs 2021). Normality was assessed using the Shapiro-Wilk test, and the Levene test was used to assess the homogeneity of variances.

Two-way ANOVA tests were computed to determine the effects of interaction between the age groups (≤75 years vs >75 years) and PI stage on the average days to heal by assessment year (2021 vs 2022). Additionally, these were used to assess the interaction between anatomic site (sacrum/coccyx, trochanter, heel, gluteus, malleolus/foot/toes, ischium, other) and stage on the average days to heal by assessment year. Data are presented as mean ± standard deviation.

All pairwise comparisons were run for each simple main effect with reported 95% CI and P value at <.05 was set as the level of significance for simple main effects of age groups. An analysis of simple main effects for the nominal variable (anatomic location) was performed using a Bonferroni adjustment, with P value set at <.007 as the level of significance.

Overall characteristics

Data were collected on 13 921 patients with PI who met the inclusion criteria. Of these, 6045 patients were treated in 2021 (Table 1). Approximately half of the participants from 2021 were female (3001 [49.6%]), with a mean age of 76.0 years ± 13.5. Data by stage of PI were as follows: 7.9% of patients had stage 1 (480), 23.5% had stage 2 (1420), 10.7% had stage 3 (646), 5.1% had stage 4 (308), 22.9% had unstageable PI (1385), and 29.9% had deep tissue injury (1806). The 2022 data comprised 7876 patients with PI (mean age, 74.4 years ± 13.4), 51.7% of whom were female. The distribution of PI stage was similar to that for 2021. In 2022, the sacrum/coccyx was the most common anatomic site (2187 [27.8%]).

Reduction in prevalence rate

The study explored the change in PI prevalence from 2021 to 2022 for the same 8-month period (Jan-Aug) at the facilities that adopted the technology as part of the comprehensive wound care program. There was a 13.1% reduction in PI prevalence (from 38.8% to 25.7%) in short- and long-term stays from 2021 to 2022 across all PI stages (Table 1).

With a calculated 1.7% decrease in the prevalence of PI stages 3 and 4, for which management costs are highest,⁸ there is the potential for a reduction in additional out-of-pocket costs (eg, bed mattress rentals, transport to specialists) of an estimated $3000 to $5000 per month per ulcer. Thus, a reduction in the number of stage 3 and 4 injuries at the rate found in the current study would result in a projected cost savings of approximately $846 618 to $1.41 million per year.

Reduction in days to healing

The participating facilities experienced a 37.4% reduction in average days to healing of PI for the period January-August 2022, an average of 17.7 days saved per PI compared with the same period in 2021 (P < .001) (Table 2). Reduction in the average days to healing was significant for all stages, with the most significant reduction observed for stages 3 and 4, with an average of 35 days saved for stage 3 PIs and almost 85 days saved for stage 4 PIs in 2022 compared with 2021 (P < .001).

With an average of 17.7 days fewer to heal a PI, and assuming 30 minutes per dressing change, 3 times per week, a projected savings of 44 808 hours of clinicians' time per year could be achieved that could be better spent on other patient care activities and improving care plans.

Effects of age and year of assessment methods on average days to healing PI by stage

Two-way ANOVA tests were conducted to examine the effects of age and year of assessment methods on average days to healing a PI by stage (Table 2). Average days to healing decreased significantly in the different age groups with the continuous adoption of the wound care model, including digital wound care technology (P < .001). However, in general, there was an observed trend of lower average days to healing among patients older than 75 years compared with those 75 years or younger across all stages. For example, for patients 75 years or younger with stage 3 PI, the estimated marginal mean time to healing was 41.2 days in 2022 compared with 80.5 days in 2021 (P < .001). For patients older than 75 years with stage 3 PI, the marginal mean time to healing was 35 days in 2022 compared with 73.9 days in 2021 (P < .001).

Effects of anatomic site of PI on average days to healing by stage per year

Two-way ANOVA tests were conducted to examine the effects of anatomic site of PIs on the average days to healing of PI by stage per year (Table 3).

Overall, the average days to healing of PI (all stages) on the sacrum/coccyx, trochanter, heel, gluteus, and malleolus/foot/toes was significantly associated with lower mean differences in days to healing in 2022 compared with 2021. From 2021 to 2022, the reduction in days to healing of PI at these anatomic sites was as follows: sacrum/coccyx, 18.9 days (P < .001; 95% CI, 24.1–39.9); trochanter, 21.3 days (P = .034; 95% CI, 18.6-50.0); heel, 17 days (P < .001; 95% CI, 24.4–41.4); gluteus, 16.2 days (P < .001; 95% CI, 8.1–28.2); and malleolus/foot/toes, 24.4 days (P < .001; 95% CI, 26.6–46.0) (Table 3).

Reduction in F686 citations

Comparison between facilities that adopted the technology vs those that did in 2021 vs 2022. The change in the proportion of F686 citations received by facilities in 2021 vs 2022 was analyzed. From 2021 to 2022, the reported proportion of total citations decreased from 15% to 8.6% in facilities that used the technology, whereas in the control group (ie, facilities that adopted the care model but had not yet adopted the technology) the proportion of total citations increased from 85% to 91.4% (Table 4).

Furthermore, from 2021 to 2022, facilities that used the technology experienced a decrease in the reported proportion of F686 citations >G, from 19.3% to 11.1%, while the control group showed an increase from 80.7% to 88.9%. Overall, only 3 of the 128 facilities using the technology in 2022 received a citation (2.3%), compared with 30 of the 181 facilities in the control group (16.6%) (Table 4).

Comparison between facilities that adopted the technology vs those that did not in 2017-2022. The authors also investigated the 6-year trend (2017-2022) in F686 citations across facilities using the technology and facilities not using the technology. Over the 6 years, 79% fewer facilities using the digital solution received citations compared with those that did not adopt the technology. Only 12% of facilities using the technology received a citation (20 of 167), whereas 91% of facilities not using the digital solution received a citation over the same 6-year period (165 of 181).

The proportion of F686 citations received by facilities using the digital solution was 11 times less than for facilities that had not used it (0.12 citation/facility vs 1.42 citation/facility). Overall, there were 7 times fewer citations with a severity of >G reported for facilities using the digital solution (12.5%) than for those that did not use the technology (87.5%) (Table 4).

This descriptive study is one of the largest to describe changes in PI prevalence rates and average days to healing; it involves more than 13 921 patients with PI at more than 100 SNFs that use a wound management technology as part of a comprehensive wound care program. The study also compared the proportion of F686 citations across a 6-year period (2017-2022) in facilities that had adopted the technology vs facilities that had not.

Many organizations use changes in PI prevalence rates to assess quality improvement in care as a result of an intervention.²⁴ The current study showed a 13.1% decrease in PI point prevalence rate across all PI stages from 2021 to 2022 for the same 8-month period (Jan-Aug), indicating enhanced quality of wound care provided to short-term and long-term residents with PI in the SNFs that had adopted the technology.

Compared with a national 10-year survey study conducted from 2006 through 2015 in the United States, the reduction in prevalence rates observed in the current study represents a 9% lower prevalence rate than the reduction reported in the national survey between 2006 vs 2015.²⁵

The patient-centered team approach adopted at participating facilities in the current study likely played a vital role in this considerable decline in the prevalence rate. In 2022, the participating SNFs in this study launched this team approach using the digital wound care technology as the locus of team alignment in order to improve PI rates. The refinement of training, coaching of clinicians on wound care practices, and use of standardized guidelines for prevention and care were critical components of this comprehensive program. The continuous enhancement to clinicians' care delivery was supported by adopting the wound care technology—one of the significant indicators in this wound care model.

One of the main elements in reducing the number of PIs highlighted by the NPIAP was correctly differentiating and identifying the PI stage.²⁶ However, because of the lack of structured wound care assessment and standardized documentation processes and the limited clinician training on proper staging and wound differentiation, competence in assessing and managing PIs remains challenging for many clinicians, resulting in suboptimal wound care for many patients.^27,28 In 2007, a survey was conducted to assess 937 nurses' responses to the National Database of Nursing Quality Indicators Pressure Injury Training Program.²⁹ The study reported that many reviewers of the training program agreed on the importance of high-quality wound images in the proper staging of PIs and wound differentiation. Evidence shows that comprehensive assessment of skin and tissues using digital technology and sound clinical judgment are vital to identifying patients at risk of PI or its complications.³⁰

This evidence aligns with the significance of adopting the digital wound management technology demonstrated in this study. In the current study, facilities that had used the technology as part of the comprehensive wound care program for more than 1 year showed a 15.9% reduction in PI prevalence, a nearly 3% improvement over facilities that had used the technology for less than 1 year.

In a feasibility study, Lau et al³¹ noted that digital wound assessment technology that captures quality images has the potential to be an effective educational tool for clinicians, enabling more efficient detection and classification of PIs. The digital capabilities of the wound care solution support clinicians in accurately capturing clinical-calibrated wound images and automatically measuring precise wound dimensions and surface area rather than relying on subjective interpretations of wound shape, which often results in inaccurate measurements. The solution enables diligent documentation of all relevant aspects of wound care to support standardized, consistent care and optimize the local wound environment. The solution also facilitates collaboration of the wound care team to ensure consistent implementation of the management plan through easy tracking of patient progress and seamless communication of wound data. Based on this study, the prevalence of PI stage, which included both new and old cases, was found to be low. It is highly probable that many old PI stage 1 cases have either healed or progressed to another stage, considering this study's average healing time of this stage was 22 to 26 days. By using images and enabling specialists to review them remotely, the chances of recognizing PI at an early stage increase significantly. This, in turn, allows for tracking of wound progress and provides an opportunity to adjust the management plan to prevent worsening. With close monitoring of and precise imaging for the same patient, new incidences of PI stage 1 in other locations could be prevented. Thus, complementing the comprehensive wound care model with digital technology boosts its effectiveness.

One of the 3 drivers of more efficient, cost-effective wound management is the prevention of wounds and wound complications.²⁴ In the current study, the observed reduction in PI prevalence rates is linked to potential cost savings. For example, a 1.7% reduction in prevalence of stage 3 and 4 PI, for which management costs are highest,⁶ could potentially result in approximately $846 618 to $1.41 million in annual cost savings of additional out-of-pocket expenses (eg, bed mattress rentals, transport to specialists) of $3000 to $5000 per month per injury. This noted savings are expected to be even higher when all direct and indirect costs are accounted for. A research study that collected PI data from public hospitals in Australia reported a $9.11 billion expenditure on PI management. This incremental cost accounts for the direct and indirect medical costs, and indirect non-medical costs, such as healthy life years and productivity loss, within the medical system based on a 12.9% PI prevalence rate.⁴

PIs with slower or extended healing periods are more likely to be associated with complications and additional treatment costs.¹¹ A UK survey study reported a 10.4% infection rate among PIs in hospitals and community providers.³² Another study reported that approximately two-thirds of chronic wounds receive systemic antibiotics at one point of treatment.³³ Complications are also associated with more exudate and dressing changes.^21,33 Therefore, preventing PIs or reducing healing times will likely result in significant cost savings due to managing these wounds and their complications.

Increased healing time is associated with increased use of dressings, nurse time, and resources, which hinders clinical capacity across a health care organization.²¹ Therefore, finding ways to enhance productivity in practice is necessary for more efficient wound management. While organizations look for ways to decrease supply expenditure, research shows that reducing supply costs is an easy cost saving measure, and it is more productive financially to consider the cost of resources required to deliver the care and the health benefits produced.^21,34 On average, wound dressings are changed approximately 3 times a week, and almost one-quarter of wounds require daily dressing changes.³⁵ This consumes health care professionals' time and increases their workload, with more dressing changes, medications, documentation, and operating time.^21,36

Thus, reducing the average number of days to healing has the potential to reduce clinicians' time managing PIs and applying dressings. One study estimated that nurses spend 60% of their time on dressing changes.³⁷ As stated previously, findings of the current study indicate that approximately 44 808 hours of clinician time could be saved with use of the technology. This is time the clinicians could use for other patient care activities and improving care plans.

The findings of the current study align with other studies that explored ways to improve clinician efficiency and productivity. A cost-effectiveness study conducted by Lindholm and Searle reported that reducing the frequency of dressing changes 1 time per week can release approximately 74 300 hours of nurses' time per year. The analysis was based on 31 minutes spent per dressing change, with dressing changes 3.5 times per week for 9760 patients with PI per year.²¹ Even with a modest saving of 5 hours of nurses' time per week, weekly management costs could be reduced up to 81.6%.²¹ Freeing up clinicians' time benefits budget and cost savings and positively affects practices. Many organizations are experiencing a shortage of nurses due to the increased rates of retirement or leaving practice that have yet to be matched with numbers of newly qualified nurses to replace them.⁴⁰ More time for clinicians could reduce nurse burnout and improve nurse retention in health care settings.³⁸ Freeing clinicians' time has the potential to optimize frontline efficiencies, thus promoting practice capacity for enhanced delivery of care.

Moreover, it is important to highlight the high indirect cost associated with PI settlements. A retrospective analysis of 141 PI cases reported that the highest monetary settlements are paid by nursing homes, with an average payout of $4 006 509, compared with an average payout of $1 596 705 for hospitals (P = .022).³⁹

In addition to a monetary settlement for neglect or malpractice, the organizational reputation can also be damaged, which can affect referrals and staff reputation.³⁶ Careful and proper documentation of clinical processes, demonstrating patient assessment profile, reference to the standardized guidelines tailored to individual needs, and the practical measures followed by the medical team to prevent or stop the progression of injury are essential to excluding organizational liability.⁴¹

In the current study, in general, across the 6-year trend (2017-2022), 79% fewer facilities using the digital solution received citations compared with facilities that did not use the solution. Furthermore, 7 times fewer F686 fines >G were reported for facilities using the wound digital solution (12.5%) than for those that did not use the digital solution (87.5%). Savings in citations >G have an approximate value of $15 000 each, which is equal to approximately $947 250 in savings using the wound care technology.

The digital solution proved its efficiency in supporting clinicians in electronically capturing all relevant aspects of clinical care and providing complete documentation, minimizing liabilities or authorization denials. A descriptive cross-sectional survey of 342 clinicians using the digital application in different care settings across the United States reported that 81% of respondents were satisfied with the solution and thought it captured accurate clinical information. In addition, 86% said they could successfully track wound progress with their patients.⁴⁰

By using the digital solution, clinicians can quickly collect objective, unbiased wound data, allowing for more effective monitoring and the ability to make better, autonomous treatment decisions in real time. Early intervention for high-risk patients can be facilitated through automated flagging, promoting faster healing, and reducing the risk of complications, ultimately improving patient outcomes and quality of life, regardless of patients' geographical location.

Thus, using technology for wound care evaluation as part of a comprehensive wound care model supports the ongoing effort to minimize PI incidence and complications in long-term care settings, thereby improving clinical outcomes and reducing costs.

The analysis focused on documenting changes in PI point prevalence rates, average days to healing a PI, and the proportion of PI citations incurred. Data were collected from over 100 SNFs providing long- and short-term care in the United States; however, the data set was limited to the skilled nursing setting and may not be generalizable to other settings (eg, acute care, home care). Although a standardized database with a uniform data collection tool and methodology were used to assess the changes in PI prevalence rates and compare between facilities across years, and although clinicians were trained to record data electronically, there were some data quality issues (eg, missing data in some cases). The study findings must be interpreted with caution, because prevalence studies cannot detect causality; additionally, observed effect should be acknowledged as an association. Future studies should control for additional variables as confounders, such as body mass index, size of PI, type of medications and preventive practices, comorbidities, continence status, nutrition, mobility, and mental status. Also, there are other measures of PI, in particular, incidence measures of acquired injuries at the specific time frame, which was not feasible to measure in this study as there needed to be more detailed information on every resident at risk in all facilities. A separate investigation would be helpful to more broadly assess the adopted tools and care model in managing PI.

Several clinical benefits are associated with the adoption of digital wound care technology as part of a comprehensive wound care program. In the current study, the care model resulted in a 13.1% reduction in PI prevalence rates, a 37.4% reduction in average healing time, and an 8% reduction in the number of >G citations at the facilities that adopted the solution. These clinical benefits were associated with direct and indirect cost saving resulting from managing these injuries and their complications. This highlights the role of an AI-powered wound management solution in improving PI rates and the necessity of adopting a broader wound care program in which clinicians fully use digital tools to maximize productivity, improve clinical outcomes, and reduce PI-related costs. Such a technology should capture high-quality images and accurate wound assessments to enable easy analysis of tissue characteristics and better prediction of wound healing and patient risk while ensuring comprehensive documentation. With more clinicians using the technology as part of a comprehensive care model, future research could focus on the incidence of institutional-acquired PIs and on further refinement of the tool to aid in controlling the increase in PI cases.

Authors: Heba Tallah Mohammed, PhD, MD¹; David Mannion, BA²; Amy Cassata, BSN, RN, WCC^1,3; and Robert D. J. Fraser, MN, RN^1,4

Affiliations: ¹Swift Medical Inc., Toronto, Ontario, Canada; ²Summit Health, Boston, MA, United States; ³Women Business Leaders of the U.S. Health Care Industry Foundation, Arlington, VA, United States; ⁴Western University Arthur Labatt Family School of Nursing, London, Ontario, Canada

Disclosure: Dr. Mohammed, Mr. Fraser, and Mrs. Cassata are paid employees of Swift Medical. The author(s) received no specific funding for this work. 

Correspondence: Heba Tallah Mohammed, PhD, MD; Associate Director, Research and Evaluation, Swift Medical Inc., Clinical Innovation, 20-210 Highland Cres, Kitchener, on N2M5H7 Canada; heba@swiftmedical.com

Manuscript Accepted: December 6, 2023