Development of an Incidence Report in a Large Quartenary Hospital

Cleveland Clinic is a 1200 bed quartenary hospital with multiple medical-surgical specialties. For years our facility was involved in yearly company sponsored prevalence in an effort to benchmark our rates and evaluate if our interventions were effective. Prevalence measures the total number of persons with a pressure ulcer in a hospital/hospital unit on the day of the pressure ulcer survey. Our facility eventually joined with NDNQI where we now provide quarterly prevalence data even though we perform monthly prevalence studies for internal trending. In an effort to drill down to look at new occurrences rather than just a snapshot in time, we researched incidence calculation through NPUAP, NDNQI and WOCN. “Calculation of incidence can be complex because in the strict definition, the time element is the sum of the time, that each patient involved in the study was at risk of a PU but was PU-free. This may be difficult or impossible to calculate precisely, therefore a less complex alternative may be used”. Incidence provides an estimate of the rate of occurrence of new patients with pressure ulcers over time. It is often measured in a simplified form called ‘cumulative incidence’. We are fortunate to have an internal database maintained by the Nursing Wound Care Team who are consulted for every pressure ulcer. Our Nursing finance experts through the billing department are able to extrapolate "unique patient days" for each unit.

              Cleveland Clinic Incidence formula:

Total number of patients developing a pressure ulcer during the specified time period

_________________________________________________                                        × 100

Total number of patients in the population over a specified time period (unique patient days)

    Units that have no pressure ulcers on Prevalence day are surprised to learn of their incidence rate. Units with a high prevalence rate are happy to learn that their incidence rate is low.