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The Emergency Department as Gateway to Inpatient Admissions: Implications for Pressure Ulcer Prevention
RATIONALE/PURPOSE
Hospital admissions are increasing, and admissions originating in the emergency department (ED) are upwards of 40% in many facilities. From 1993 to 2006 ED-based admissions increased by 50%. The ED may be an important site to initiate pressure ulcer (PrU) prevention.
OBJECTIVE
Describe demographic characteristics, pressure ulcer risk factors, and ED length of stay in a sample of hospital inpatients.
METHODOLOGY
Data was analyzed from a PrU audit database maintained by a support surface manufacturer as a service for facilities conducting routine PrU prevalence audits. All data is deidentified and HIPPA compliant. Audit inclusion criteria were: acute care facility, audits from 2014 or 2015, data on minimum of 40 patients.
RESULTS
A total of 6,924 patients from 30 facilities are included in analysis. The patients were a majority female (52%) with a median age of 67 (range 0-90, ages were truncated at 90 to protect patients’ privacy). Patients’ top five primary diagnosis categories were: cardiovascular (20%), pulmonary (15%), gastrointestinal (15%), neurological (13%), and skeletal (11%). Based on Braden Scale scores on admission, 47% of patients were considered to be at risk for PrUs. Specific PrU risk factors included fecal incontinence (35%), urinary incontinence (33%), Foley catheterization (47%) and PrU history (9%). 64% of patients spent some time in the ED prior to hospital admission, and 37% spent more than 4 hours in the ED.
DISCUSSION
Many of the patients in the current sample were at risk for pressure ulcers and spent time in the ED prior to hospital admission. This suggests opportunities for initiation of PrU prevention measures in the ED.
LIMITATIONS
The size of the database is small and limits generalization beyond the sample of acute care facilities that participate in the audit survey.