Abstract and Introduction
Introduction: The consistency of coding the reported severity of pressure injuries (PIs) present on arrival and hospital-acquired PIs remains unknown.
Objective: The authors conducted a 3-year retrospective review of hospitalized patients from 200-, 400-, and 700-bed acute care facilities before (preimplementation, year 1) and after (postimplementation, years 2 and 3) introduction of the mobile wound management system application (WMS app).
Materials and Methods: On October 1, 2018, the WMS app and an accompanying educational initiative were rolled out to hospital staff at all 3 facilities.
Results: The number of PIs determined to be present on arrival was significantly different between years 1 and 2 at both the 200-bed facility (P =.0221) and the 400-bed facility (P =.0138) and between years 2 and 3 at the 400-bed facility (P <.0001). There was a significant difference in the number of stage 3 and stage 4 PIs among all PIs reported between preimplementation and postimplementation (P =.0456), between years 1 and 3 (P =.0068), and between years 2 and 3 (P =.0382) at the 200-bed facility, as well as between preimplementation and postimplementation (P =.0072), between years 1 and 2 (P =.0284), and between years 1 and 3 (P =.0076) at the 400-bed facility. At the 400-bed facility, there was a significant difference in the number of hospital-acquired conditions (HACs) among all reported PIs between years 1 and 2 (P =.0427) and between years 2 and 3 (P =.00009). At the 700-bed facility, there was a significant difference in the number of HACs among all reported PIs between preimplementation and postimplementation (P =.00004), between years 1 and 2 (P =.0013), and between years 1 and 3 (P =.0038).
Conclusions: This study shows that the WMS app was successfully implemented, and its use enhanced overall wound care.
Pressure injuries (PIs) continue to burden the health care industry, affecting approximately 2.5 million patients and accounting for approximately 60 000 deaths annually in the United States. Pressure injuries also have a negative financial effect on the US health care system and are associated with an additional annual cost of $43 000 per related hospital stay and a $25 billion overall total cost nationally. Although there are existing PI staging criteria to aid in patient care, these criteria have shortcomings.
The Braden Scale is an assessment tool used to predict low, medium, and high risk for PI to aid in identifying early prevention efforts that can be implemented to prevent PI; it is not used for staging wounds or wound status. The Bates-Jensen Wound Assessment Tool (BWAT), the Pressure Ulcer Scale for Healing (PUSH), and the Healing Progression Rate tool (HPR [a modified version of the PUSH tool]) are used to assess wound status.[3,4] Each tool includes questions and criteria for assigning a score. To begin, a baseline score is determined, after which the particular tool is repeated periodically to document wound status over time (same, better, or worse), depending on how the score fluctuates. None of the aforementioned tools assist with wound staging to accurately comply with the National Pressure Injury Advisory Panel (NPIAP) criteria, however.
The primary purpose of this study is to assess the consistency in coding the reported severity of PIs present on arrival (POA) and the severity of hospital-acquired PIs (HAPIs) before and after the implementation of a redesigned wound assessment tool. The original tool was developed as a paper cutout that was to be placed adjacent to/bordering a wound to aid in PI assessment. With this in mind, a wound management system (WMS) was designed to electronically integrate the tool within a mobile application. The WMS combines both electronic photography and documentation in a mobile application that was used alongside a developed expert assessment team focused on a consistent formula for assessing and coding PIs.
A previous version of the aforementioned physical tool, the NE1 Wound Assessment Tool (WAT) (Medline Industries, LP), has been shown to be highly reliable, validated, and easily implemented by registered nurses (RNs).[3,5,6](The study device was invented by author N.E.) To facilitate easier use of wound photography and management of PIs, a smartphone application that integrates the WAT was developed. The NE1 Wound Management System mobile application (WMS app; Medline Industries, LP) was designed to simplify wound classification and better assist health care workers in the assessment of skin alterations, wounds, and PIs. The updated WMS was studied in years 2 and 3 in this 3-year retrospective review. During year 1, the original WAT was used.
The Centers for Medicare & Medicaid Services (CMS) incentivizes the practice of quality care. With changes made to the reimbursement policy in the past decade for PIs, the CMS provides an additional payment based on the Medicare Severity-Diagnosis Related Group (MS-DRG) code for the care of more severe PIs (stage 3 and 4) that are POA.[7,8] This reimbursement MS-DRG code is not available if the PI is a HAPI or a hospital-acquired condition (HAC). Therefore, it has become increasingly important to capture an adequately staged and coded PI that is POA. The WAT has been shown to improve the accuracy of PI staging with a resultant increase in reimbursement with use of MS-DRG coding. However, the financial implications of using the WMS app in the acute care setting have yet to be adequately studied in the clinical literature.
A 3-year retrospective review was conducted to determine whether the use of the WMS app affected trends in coding quality and MS-DRG–related reimbursement potential for PIs across 3 acute care facilities (200-, 400-, and 700-bed). Notable patterns related to the number of PIs POA were analyzed to determine changes in coding and quality before and after implementation of the WMS app at these facilities.
Wounds. 2022;34(7):185-194. © 2022 HMP Communications, LLC