Costs and consequences of an intervention-based program to reduce hospital-acquired pressure injuries in one health district in Australia
Michelle Barakat-Johnson
A B F , Michelle Lai B C , Timothy Wand B D , Kathryn White B C and Richard De Abreu Lourenco E
+ Author Affiliations
- Author Affiliations
A Sydney Local Health District Executive Nursing, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
B Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Mallet Street, Camperdown, NSW 2050, Australia. Email: michelle.lai@sydney.edu.au; tim.wand@health.nsw.gov.au; kate.white@sydney.edu.au
C Cancer Nursing Research Unit, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia.
D Emergency Department, Royal Prince Alfred Hospital, Sydney Local Health District, Missenden Road, Camperdown, NSW 2050, Australia.
E Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Block D, Building 5, 1 Quay Street, Ultimo, NSW 2007, Australia. Email: richard.deabreulourenco@chere.uts.edu.au
F Corresponding author. Email: michelle.barakatjohnson@health.nsw.gov.au
Australian Health Review 43(5) 516-525 https://doi.org/10.1071/AH18131
Submitted: 25 June 2018 Accepted: 9 October 2018 Published: 11 February 2019
Abstract
Objectives The aims of this study were to determine the costs of hospital-acquired pressure injuries (HAPIs) in one local health district in Australia and compare the costs and consequences of an intervention-based program with current practice to reduce HAPI incidence and prevalence.
Methods A retrospective cost–consequence analysis was conducted using HAPI incidence rate per occupied bed days, point prevalence rates, Australian Refined-Diagnosis Related Group (AR-DRG) costs and the costs of the program to reduce the HAPI rate. Data were analysed for two phases: preprogram implementation (1 June 2015–1 June 2016) and postprogram implementation (1 August 2016–31 July 2017).
Results The HAPI intervention-based program resulted in a 51.4% reduction in the incidence of HAPI (from 1.46 per occupied bed day in 2014 to 0.71 per occupied bed day in 2017) and a 71.6% reduction in the prevalence of HAPI (from 6.7% in 2014 to 1.9% in 2017). The occurrence of HAPI added an average cost of A$3332 per episode, such that the overall program, including implementation, reduced costs by A$837 387. The greatest cost reduction was due to the cessation of washable and disposable underpads. The largest contributor to the cost of HAPI prevention was for education and training regarding HAPI prevention initiatives.
Conclusions The HAPI intervention-based program halved the incidence and substantially reduced the prevalence of HAPI, with a 23.1% cost saving compared with the previous approach to preventing HAPIs.
What is known about the topic? HAPIs are costly to the individual, the organisation and health system. The prevention of HAPIs is a priority in Australia. There is limited research on the economic effect of HAPIs and the costs and consequences for hospitals of implementation strategies to reduce their incidence.
What does this paper add? This paper informs health policy and decision makers about the costs and consequences for a local health district of a program to reduce and prevent HAPIs. This paper reports the economic effect of HAPIs, including hospital episode costs per HAPI and length of stay, on one local health district.
What are the implications for practitioners? This cost–consequence analysis has shown that the program to reduce HAPIs resulted in a reduction in expenditure and positive patient outcomes. Such a program is potentially transferable to other healthcare settings.
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