Multidisciplinary Surgical Team Approach to Decrease Sacral Hospital Acquired Pressure Injuries: A Retrospective Study Shelby Isaacs, BS1, Tamir Pinhasov, BA1, Alisha Oropallo, MD1,2,4, Mary Brennan, RN3, Amit Rao, MD1, Gregg Landis, MD2,4, Marie 3 5 Agrell-Kann, RN , and Timmy Li, PhD 1Department
of Surgery, Comprehensive Wound Care Healing and Hyperbarics, Northwell Health, Lake Success, NY 11042, USA 2Deparmtent of Vascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11550, USA 3Department of Nursing, North Shore University Hospital, Manhasset, NY 11030, USA 4Department of Vascular Surgery, North Shore University Hospital, Manhasset, NY 11030, USA 5Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11550, USA
Background Hospital-acquired pressure injuries (HAPIs) of the sacrum are among the most common iatrogenic events in healthcare, resulting in prolonged hospital stays, increased mortality, and a significant cost burden1. Although initiatives to decrease the incidence of HAPIs have been created, optimal methods of reduction remain to be determined. The objective of this study was to assess changes in yearly incidence of sacral HAPIs before and after implementation of a three-pronged intervention aimed to reduce the incidence of HAPIs.
Hypothesis
Results In NSUH, in the pre-intervention years (20102011), the mean incidence of sacral HAPIs was 0.310% - a total of 294 cases. In the postintervention years (2013-2017), the mean incidence of sacral HAPIs was reduced to 0.019% - a total of 49 cases (p<0.0001). In addition, there was a statistically significant decrease in the median hospital length of stay in the post-intervention period compared to the preintervention period (13 days vs. 19 days, p=0.0096) Figure 1: Incidence of Sacral Healthcare-Associated Pressure Injuries by Year
We hypothesized that the yearly incidence of HAPIs would decrease after the intervention period.
Methods In 2012, a three-pronged intervention involving (1) a multidisciplinary surgical team, (2) enhanced education for nursing staff, and (3) enhanced quality data reporting was implemented. Yearly incidence of sacral HAPIs before and after implementation of the intervention were tracked in patients in North Shore University Hospital (NSUH).
Conclusions The implementation of a multidisciplinary surgical team, enhanced education for nursing staff, and enhanced quality data reporting was associated with a reduction in the incidence of sacral HAPIs.
Limitations/ Future Direction There are several limitations of this study to acknowledge: 1) The multidisciplinary surgical team implemented for this study was comprised of staff from numerous specialties. Smaller institutions may not have the resources or staff to implement this intervention. 2) Our intervention consisted of three components, and it is difficult to determine which component played the largest role in decreasing the incidence of sacral HAPIs. Additional studies are needed to determine whether a smaller care team can reduce the incidence of HAPIs as well to test each of the intervention components separately and with a larger sample size.
Resources Note: Vertical dotted line represents the year 2012, in which the intervention was implemented. Years 2010 to 2011 represent the pre-intervention period and years 2013 to 2017 represent the post-intervention period.
1) Lyder CH, Wang Y, Metersky M, et al. Hospitalacquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. J Am Geriatr Soc. 2012;60(9):1603-1608. doi:10.1111/j.1532-5415.2012.04106.x