Unintended consequences of quality improvement programs on the prevention of hospital-acquired conditions: Avoiding the temptation to bite into low-hanging fruit

Abstract

Hospital-acquired conditions such as pressure injuries, falls, and infections are common, costly, and deadly. Addressing the simultaneous needs of evidence-based prevention guidelines for multiple conditions can be challenging for clinical teams. Current payment incentives created by The Centers for Medicare and Medicaid Services using the Agency for Healthcare Research and Quality Patient Safety Indicator 90 (PSI90) measure impact how clinical resources are allocated by prioritizing conditions that are simpler and less costly to prevent. Pressure injury prevention guidelines may be one of the more complex programs for hospitals to implement due to the financial investment in nursing time and technology. However, a quality improvement program focused around pressure injury prevention holds good value by tackling many of the tangential conditions caused by issues related to the decubitus patient and mobility, including fall injury, venous thromboembolism, catheter-associated urinary tract infection, and sepsis. Hospitals should reconsider their prioritization of different patient safety indicators, and The Centers for Medicare and Medicaid Services should create more focused payment incentives on harmful hospital-acquired conditions such as pressure injury that are independent of composite measures of harm, including PSI90.