Academic journal article Australian Health Review

Pressure Injury in Australian Public Hospitals: A Cost-of-Illness Study

Academic journal article Australian Health Review

Pressure Injury in Australian Public Hospitals: A Cost-of-Illness Study

Article excerpt

Introduction

Pressure injury (PI) is considered one of the most common causes of iatrogenic harm to patients.1 It is associated with sustained pain, discomfort and increased immobility and mortality rates in addition to decreased quality of life in both acute and long-term care settings.2,3 It also carries a substantial financial burden associated with ongoing care incurred by individuals and families, the healthcare system and society. As a preventable condition, PI prevalence is being measured nationally and internationally as an indicator of quality of nursing care in health facilities, and complainants in litigation can be awarded substantial costs.4-6 In Australia, The National Safety and Quality Health Service Standards provide health service leaders guidance on areas to target in improvement strategies. Standard 8, Preventing and Managing Pressure Injury, requires health service organisations to implement evidence-based systems to prevent PIs and to manage them when they do occur.7 Yet, hospital-acquired PI remains an unsolved problem.

The treatment for PIs is known to be costly; however, there is little precise information on prevalence and costs.8 The prevalence rate, and subsequently estimated number of PI cases, varies significantly from one study to the next. Studies have reported prevalence rate estimates ranging from 2 to 23%2,9-17 and incidence rates between 1.5 and 38%.18-22 In Australia, the overall reported PI prevalence between 1983 and 2002 ranged between 3 and 36.7%.23 The variation is associated with healthcare setting (acute care vs long-term care vs home care), disease specific (e.g. spinal cord injury, cardiovascular etc.) and data collection methods (e.g. hospital surveys, patient-level data).34 More specifically, state-wide audits estimate PI prevalence in hospitals ranges from 9.5 to 17.6%.10 Studies in nursing home and long-term care settings estimate the prevalence of PI to be around 8.9%.25,26

Similarly, studies investigating the financial burden associated with PIs have presented a wide range of estimates along several dimensions, such as degree of severity (Stage I to IV),27 additional length of stay (LOS) attributable to PIs and whether PIs occurred in medical or surgical patients.16,19,22,28 The variation in cost per case is substantial, with estimates ranging between US$500 and US$40 000 in the US9,29 and from £1214 for Stage I to £14 108 for Stage IV in the UK.17 Findings suggest that personnel costs, such as nursing and carers' time, contribute a large proportion of the total treatment cost, whereas the use of medical materials, special beds and mattresses only make a minor contribution.30 For severe cases, complications that lead to delayed healing, additional diagnostic tests and monitoring and extended LOS are a major determinant of cost.16 Subsequently, there is a wide range of cost estimates associated with PI treatment across countries (from millions to billions of dollars),2,8,9,16,30,31 representing between 0.4 and 6.6% of a country's health expenditure.

There have been studies on the prevalence and economic losses of PI in Australia. Graves et al. estimated the impact of PI on in-patient LOS, as well as the opportunity cost of bed days lost using 2001-02 data.19,32 Jackson et al.33 reported that PI ranked among the top five hospital-acquired complications (by total additional system cost). Based on data from 2005-06 (Victoria) and 2006-07 (Queensland), Jackson et al. reported the total number of PI cases to be 2873, representing a prevalence of 0.2% (much lower than the prevalence estimated in other studies1,34,35) and a total cost of A$22.9 million for the public hospitals in these two states.33 It is noted that this prevalence rate, and thus estimated cost, was likely to be underestimated. Jackson et al.33 derived the estimates from data collected retrospectively using the Diagnosis-Related Group (DRG) system, whereas the state reports1,34,35 estimated their prevalence rates from prospective prevalence surveys where PI was recorded through direct skin inspection, which was more likely to be more accurate. …

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