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The Value of Reducing Hospital-Acquired Pressure Ulcer Prevalence: An Illustrative Analysis

Spetz, Joanne PhD, FAAN; Brown, Diane S. PhD, RN, CPHQ, FNAHQ, FAAN; Aydin, Carolyn PhD; Donaldson, Nancy DNSc, RN, FAAN

JONA: The Journal of Nursing Administration: April 2013 - Volume 43 - Issue 4 - p 235–241
doi: 10.1097/NNA.0b013e3182895a3c

OBJECTIVE: The aim of this study was to assess the cost savings associated with implementing nursing approaches to prevent hospital-acquired pressure ulcers (HAPU).

BACKGROUND: Hospitals face substantial costs associated with the treatment of HAPUs. Interventions have been demonstrated as effective for HAPU prevention and management, but it is widely perceived that preventative measures are expensive and, thus, may not be a good use of resources.

METHODS: A return-on-investment (ROI) framework from the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators Toolkit was used for this study. The researchers identified achievable improvements in HAPU rates from data from the Collaborative Alliance for Nursing Outcomes and measured costs and savings associated with HAPU reduction from published literature.

RESULTS: The analysis produced a baseline ROI ratio of 1.61 and net savings of $127.51 per patient.

CONCLUSIONS: Hospital-acquired pressure ulcer surveillance and prevention can be cost saving for hospitals and should be considered by nurse executives as a strategy to support quality outcomes.

Supplemental Digital Content is available in the text.

Author Affiliations: Professor (Dr Spetz), Philip R. Lee Institute for Health Policy Studies, and School of Nursing, University of California, San Francisco; Strategic Leader (Dr Brown), Hospital Accreditation Programs, Kaiser Permanente Northern California, Oakland; Senior Scientist (Drs Brown and Donaldson); Data Management Services Director (Dr Aydin), Collaborative Alliance for Nursing Outcomes (CALNOC), San Ramon, California; Research Scientist (Dr Aydin), Cedars-Sinai Medical Center and Burns and Allen Research Institute, Los Angeles, California; Clinical Professor and Director (Dr Donaldson), UCSF Centre for Evidence-Based Quality Improvement–A JBI Affiliate Centre, School of Nursing, University of California, San Francisco.

This intramural research was funded by CALNOC.The authors were paid consultants for CALNOC for this research, and Drs Brown, Donaldson, and Aydin are part of the CALNOC Operations Team.

Correspondence: Dr Spetz, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118 (

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© 2013 Lippincott Williams & Wilkins, Inc.