The U.S. healthcare system spends billions of dollars each year on wound care. To lower those costs while improving outcomes, leading health systems are looking into standardizing wound care protocols.
During a February webinar sponsored by Sodexo, Julie Branham, Vice President for Global Clinical Nutrition at Sodexo, moderated a discussion with three experts about how wound care protocols can improve financial performance and practical steps to implementing such protocols. Panelists were:
- Jennifer Jamal, Clinical Liaison, Abbott
- Rafael Rafols, MD, Certified Wound Care Specialist Physician
- Rohit Sharma, Director, Quality, Patient Safety and Regulatory Affairs, NYC Health + Hospitals
Key themes from the discussion are summarized below.
Wounds, including hospital-acquired pressure injuries (HAPIs), are extremely costly
Annually, 10.5 million Medicare patients are affected by wounds, of which 2.5 million patients are affected by HAPIs.
The average length of stay for patients with HAPIs is 10.8 days, nearly 77% of these patients require post-acute care and their risk of readmission is up to two times higher. Further, care costs per HAPI range from $20,000 to $151,000 and an estimated 60,000 patients die each year as a direct result of HAPIs.
In addition, more than three-quarters of Medicare inpatients have nutrition-related risk factors for HAPIs, since malnutrition increases the risk of developing a pressure injury.
Because of their impact on health and financial outcomes, HAPIs have been added to the CMS Electronic Clinical Quality Measure (eCQM) guidelines for 2025, which include recommendations for nutrition screening and incorporation of evidence-based protocols. Although compliance with eCQM is voluntary, a high rate of HAPIs can lead to lower quality scores and reduced reimbursements for hospitals.
“There may also be legal implications such as medical malpractice suits — so some of the penalties are financially direct, while others are secondary,” Mr. Sharma said.
Most HAPIs can be prevented through better education and nutrition
Although some pressure injuries are unavoidable, the vast majority are preventable.
However, because no two wounds are the same, it is important to risk-stratify patients, Dr. Rafols said. “We have our ‘frequent flyers’ — patients who are well known with pressure injuries, with strokes, with paraplegia or those with significantly advanced dementia, which can lead to development of functional quadriplegia.”
Raising awareness of the importance of patient risk stratification is a component of the better education clinicians need around HAPI prevention. Risk stratification is important not only for assessing patients’ risk of HAPI upon admission, but also at discharge, Dr. Rafols noted.
Another factor that plays a crucial role in preventing as well as treating HAPIs is nutrition. This is why registered dietitians should be incorporated into teams that care for patients with wounds or at elevated risk of developing wounds, Ms. Jamal said.
“Poor nutrition is a major predictor of skin breakdown and advancing wounds, so dietitians should be at the table when hospitals are discussing standardizing care for these patients.” Ms. Jamal added. She said that dietitians are also essential for addressing barriers to meeting patients’ nutritional needs, such as swallowing issues, poor appetite or access to food post-discharge.
Implementing interdisciplinary care protocols is key to effective and efficient wound management
One of the first steps provider organizations looking to improve wound care management can take is to review current processes and identify potential gaps.
Because dietitians play a vital role in wound care, they are a key stakeholder in that assessment. Questions to ask dietitians that can reveal potential wound care management gaps include:
- How much time passes between an admission and when a dietitian is notified that they have to see the patient?
- How many days lapse before wound care patients are discharged?
- How can we educate patients on proper nutrition before they leave the hospital?
Another key step is to consider all stakeholders involved in wound care management and decision-making. In addition to dietitians, stakeholders typically include primary care and specialist physicians, nursing leaders, executive leadership and, importantly, the IT team.
“We can have great pie-in-the-sky ideas, but if the EMR can’t support them, we need to figure out other avenues,” Ms. Jamal noted. “Having IT involved early in the process is important because they can shave back hours of frustration clinicians might feel when trying to implement something in the EMR.”
Dr. Rafols acknowledged the important contributions of other professionals, too. “Wound care is a team sport, so we work very closely with case management and social workers as well.”
Streamlining processes, involving all relevant stakeholders and providing wound care consistently across facilities is the basis of standardized wound care protocols. Ms. Jamal noted significant reductions in both HAPIs and care costs at organizations that have implemented standardized approaches. In the Midwest, some health systems have achieved between $1,500 and $3,800 in net savings on each patient’s stay “just by incorporating nutrition and standardizing care flows,” she concluded.
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