Pressure Redistribution Mattresses Save Money - Even in the ER

Bedsore is an old fashioned word and the idea that it’s only a problem for long term care facilities and ICUs is an old fashioned idea. A study to be released in the Annals of Emergency Medicine highlights the fact that pressure ulcers can start even in the ER. Pham et al. found that pressure redistribution foam mattresses are a highly cost effective means of preventing pressure sores for elderly patients treated in the Emergency Department. The focus on elderly patients is germane because they are at higher risk, especially if they suffer from poor nutrition, and or, incontinence. Putting these patients on the pressure redistribution mattresses cost as little as 30 cents per patient and saved the hospital much more. The finding is surprising since patients aren’t expected to stay long in ERs. But as little as one hour on an unyielding mattress or stretcher can damage the skin of some patients.

Like most people, I hadn't spent a lot of time thinking about pressure sores. They aren't mentioned much by researchers or by the press. I've learned this week that they cause much more suffering than their under-the-radar status would suggest. For patients and their loved ones ulcers are painful. Some of that suffering, it seems to me though, comes from the general belief that pressure sores are entirely unnecessary. And the public doesn't get that idea out of the blue. The Center for Medicare and Medicaid Services considers pressure sores to be HACs (hospital acquired conditions) that is, entirely preventable and has refused to reimburse for treating them since 2008. And "pressure" to prevent them has climbed even further since New Jersey passed a law in 2009 allowing the state to release hospital specific data on fourteen medical mistakes. It includes pressure ulcers on that list. But is this really fair? Is every pressure sore avoidable? The research just doesn't support that conclusion.

Now don't get me wrong. I'm not suggesting that high rates of sores aren't a sign of poor care, obviously they are. And I'm not saying that there's not room for improvement, there is, plenty of room. The 2008-2009 International Pressure Ulcer Prevalence Survey gives a good general overview of the problem. In the US they found that 5 percent of all patients in acute care facilities acquired ulcers. Long-term care, had higher rates. The National Pressure Ulcer Long-term Care Study (NPULS) reported that in 2002 an average of 9.8 percent of residents had them. But the idea that pressure sores are "never events" things that wouldn't occur without someone making a mistake, is cruel. It makes patients feel worse and puts the blame on the care institution, (essentially the nurses) when the real culprit is the illness itself.

Even the best regimen can't fully prevent sores. At least one Egyptian mummy has been found with pressure ulcers,even though one presumes the person was tended by slaves. Added to the general stress that being bed bound puts on skin is the fact that contemporary medicine requires so many patients be hooked up to lines and tubes, especially in intensive care. Ten percent of ulcers are associated with such devices. And even for patients in less intensive settings, being bed bound is associated with some risk. Tom DeFloor, Head of the Ghent University Nursing Science Unit, did a series of randomized, controlled studies looking for the optimal way to manage immobile patients and prevent pressure sores. In 2007 he compared 237 nursing home residents who were repositioned every four, three or two hours. The best outcome came when patients were turned every four hours. Moving them twice as often didn't actually improve results. (International Journal of Nursing Studies 48 (2011) 787–79).

The most striking thing about this study was that even the best routine didn't take the number of pressure sores to zero. The best they could manage was about 3 percent prevalence rate. In another randomized, controlled study Professor DeFloor found that foam pressure redistribution mattresses were just as effective at preventing sores as alternating pressure mattresses. This is excellent news because alternating pressure mattresses are much more expensive. (IBID.)

If every patient who needs it is put on a foam pressure distribution mattress the financial savings is likely to be considerable. In its 2010 Patient Safety in American Hospitals Study Healthgrades estimated that pressure ulcers alone added 2.6 billion in added costs between 2006 and 2008. The British National Health Service estimated that a single severe sore can take three months to heal and cost 40,000 pounds (64,859 dollars). The mattresses that patients lie on are the most direct experience of the therapeutic environment that they have. Luckily they are a simple and relatively inexpensive element to change for the better.

Web Links

The National Pressure Ulcer Advisory Panel has a prevention tip sheet.

Hospital Compare, the US Department of Health & Human Services site has a database of hospital acquired condition (HAC) rates that it lists by hospital.

HealthGrades, Inc. The Seventh Annual HealthGrades Patient Safety in American Hospitals Study.