Despite the amount of existing research devoted to localized pressure injuries developing in inpatient settings, this problem still gathers research groups’ attention. In their study, Rondinelli et al. (2018) explore the cases of hospitalized patients in California with reference to the incidence of hospital-acquired pressure injuries (HAPIs). The text of the article displays a clearly articulated purpose. It consists of using data from California’s integrated healthcare to expand the scientific community’s understanding of the incidence of HAPIs, risk factors for such conditions, and variation between separate healthcare institutions in terms of HAPIs. Concerning research designs, this quantitative study exemplifies longitudinal retrospective cohort research. Since the article reports one study’s results, the design makes the study represent level III evidence as per the LOE pyramid.
The study’s sample and data collection methods are adequately aligned with the stated purpose. Using the information regarding patients hospitalized in California between January 2013 and June 2015, the researchers collected a sample exceeding 728 thousand hospitalizations, including over 1660 HAPI instances (Rondinelli et al., 2018). Over 466 thousand individuals from 35 different settings in California were included in the sample, with more than 30% having multiple hospitalizations (Rondinelli et al., 2018). Regarding strategies for collecting data, the researchers used the involved hospitals’ information systems and performance quality data to capture various variables, including patients’ demographics, admission/discharge dates, diagnosis/comorbidities, HAPI instances with timing, and similar information. In data collection, the authors also applied clear inclusion criteria for episode selection purposes, such as timing, appropriate location, patients’ age, and reasons for hospitalization non-related to mental health, peripartum care, or rehabilitation services. Sample size and clarity in data selection could support the study’s replicability and generalizability.
The article’s findings answer the research questions explicitly and summarize the HAPI-related situation for Californians hospitalized between 2013 and 2015. As per the analysis of all patients’ HAPI statuses, the issue’s incidence in the selected hospitals was 0.57 per 1000 inpatient days or 0.2% of all hospitalization episodes (Rondinelli et al., 2018). The researchers also established a variety of factors inversely correlated with the risks of developing HAPIs. The protective factors varied from demographic ones, for instance, female sex, to health circumstances, including scoring high on the Braden scale and hospital admissions with emergency conditions (Rondinelli et al., 2018). As for inter-hospital variation in relation to HAPIs, it remained significant after accounting for risk factors varying between different patients.
The work’s unique strengths and limitations deserve attention to make an informed source selection decision. The potential disadvantages stem from the findings’ and the selected statistical models’ unknown applicability to settings in healthcare systems that are structurally different from California’s system (Rondinelli et al., 2018). Additionally, no opportunity for gathering and analyzing inpatients’ BMI scores might have certain negative impacts on the findings’ relevance to real cases. Nevertheless, the source’s strengths are great in number and include generalizability stemming from a large sample and the research design’s usefulness for studying relatively uncommon exposures. Finally, due to design selection, the study effectively tracks various pressure ulcers’ emergence, including the uncommon cases in which skin damages take days to become visible.
The source’s potential applications for future practice relate to pressure ulcer risk assessments. The article shows clear links between high scores on the Braden scale and lower risks of HAPIs, thus highlighting the tool’s potential in preventing complications (Rondinelli et al., 2018). Considering this, the source further reinforces the need for ubiquitous implementation of the Braden scale for the nursing assessments of hospitalized patients. Moreover, based on the article, care providers are recommended to instrumentalize severity-of-illness scores and comorbidity burden measurements to take the accuracy of HAPI risk evaluations to the next level (Rondinelli et al., 2018). In spite of increasing risk assessments’ complexity, such measures could support patient safety even more.
Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-acquired pressure injury: Risk-adjusted comparisons in an integrated healthcare delivery system. Nursing Research, 67(1), 16-25.