Media Releases

Better mattresses improve care, cut hospital costs: U of T study

August 17, 2011

TORONTO, ON —Hos­pi­tals could reduce health care costs aris­ing from pres­sure ulcers, com­mon­ly known as bed­sores, by invest­ing in pres­sure-reduc­tion mat­tress­es for elder­ly patients in emer­gency depart­ments, accord­ing to new research from the Uni­ver­si­ty of Toron­to.

In emer­gency depart­ments (EDs), elder­ly patients are at high risk for pres­sure ulcers in part because they spend hours lying on hard sur­faces. The researchers found that while the aver­age cost of upgrad­ing from stan­dard to pres­sure-redis­tri­b­u­tion mat­tress­es would be 30 cents per patient, the cor­re­spond­ing reduc­tion in pres­sure-ulcer inci­dence would pro­duce sav­ings of $32 per patient.

“Most pres­sure ulcers are pre­ventable, which is why the U.S. Cen­ters for Medicare and Med­ic­aid Ser­vices con­sid­ers them a ‘nev­er event’ and won’t reim­burse their treat­ment,” said Ba’ Pham, lead author on the study and a senior research asso­ciate with the Toron­to Health Eco­nom­ics and Tech­nol­o­gy Assess­ment (THETA) Col­lab­o­ra­tive. “Upgrad­ing mat­tress qual­i­ty would save mon­ey and improve qual­i­ty of life for elder­ly patients in emer­gency depart­ments,” said Pham, who is also com­plet­ing his train­ing at U of T’s Depart­ment of Health Pol­i­cy, Man­age­ment and Eval­u­a­tion.

In their study, pub­lished in Annals of Emer­gency Med­i­cine, the researchers per­formed a cost-effec­tive­ness analy­sis based on data drawn pri­mar­i­ly from Ontario. They com­pared the pro­ject­ed inci­dence of pres­sure ulcers based on cur­rent prac­tices in EDs with pro­ject­ed inci­dence after intro­duc­tion of bet­ter mat­tress­es and found that ear­ly pre­ven­tion was like­ly to be cost-effec­tive 81% of the time.

As part of their study, they also con­duct­ed a small sur­vey of Ontario EDs and found that only 12% of stretch­ers and beds have pres­sure-reduc­tion mat­tress­es. Annu­al­ly in Ontario, about 240,000 elder­ly patients are admit­ted to EDs; the researchers’ mod­el sug­gest­ed that pro­vid­ing bet­ter mat­tress­es for these patients would pre­vent 1,005 pres­sure ulcers and save $7.2 mil­lion in health care costs.

“Pres­sure ulcers are a huge but under­ap­pre­ci­at­ed prob­lem across mul­ti­ple set­tings in our health care sys­tem,” said Prof. Mur­ray Krahn, prin­ci­pal inves­ti­ga­tor on the study who is a Pro­fes­sor in the Depart­ment of Med­i­cine and Fac­ul­ty of Phar­ma­cy at U of T and the Direc­tor of THETA. “Though they are not the full solu­tion, pres­sure-reduc­tion mat­tress­es are an inex­pen­sive and easy way to address the prob­lem, par­tic­u­lar­ly among elder­ly patients admit­ted to EDs.”

In oth­er stud­ies, the researchers have found poten­tial for cost reduc­tion through pres­sure-redis­tri­b­u­tion mat­tress­es in oper­at­ing rooms, long-term care homes and oth­er facil­i­ties. Through THETA, they are work­ing toward imple­ment­ing a province-wide strat­e­gy on pres­sure-reduc­tion mat­tress­es with the Ontario Health Tech­nol­o­gy Advi­so­ry Com­mit­tee (OHTAC) and the Med­ical Advi­so­ry Sec­re­tari­at at Health Qual­i­ty Ontario, an inde­pen­dent agency that mon­i­tors and pro­motes improve­ments in health care in Ontario.

Although OHTAC issued evi­dence-based rec­om­men­da­tions in 2009 on pre­vent­ing pres­sure ulcers that includ­ed use of bet­ter mat­tress­es in EDs, oper­at­ing rooms and long-term care facil­i­ties, Pham said the province and coun­try still lack a cohe­sive and effec­tive strat­e­gy. “We need active poli­cies in Cana­da to trans­fer our knowl­edge into prac­tice,” said Pham. “But I expect change will hap­pen, because the bur­den of pres­sure ulcers is so high and invest­ing in bet­ter mat­tress­es is vir­tu­al­ly a one-time change.”


This study was con­duct­ed by the fol­low­ing researchers: Ba’ Pham (Toron­to Health Eco­nom­ics and Tech­nol­o­gy Assess­ment Col­lab­o­ra­tive [THETA], Uni­ver­si­ty of Toron­to), Lau­ra Teague (Wound Care Pro­gram), Dr. James Mahoney (Divi­sion of Plas­tic Surgery, Depart­ment of Surgery, U of T) Lau­rie Good­man (Skin and Wound Care, Cred­it Val­ley Hos­pi­tal), Mike Paulden (THETA), Dr. Jeff Poss (Depart­ment of Health Stud­ies and Geron­tol­ogy, Uni­ver­si­ty of Water­loo), Dr. Jian­li Li (Deci­sion Sup­port Ser­vices, St. Michael’s Hos­pi­tal), Luciano Ieraci (THETA), Steven Car­cone (THETA), Dr. Mur­ray Krahn (THETA).

Fund­ing for this study was pro­vid­ed in part by Health Qual­i­ty Ontario and the Ontario Min­istry of Health and Long-Term Care through THETA. The THETA Col­lab­o­ra­tive pro­vides tech­nol­o­gy assess­ment sup­port for the Ontario Health Tech­nol­o­gy Advi­so­ry Com­mit­tee and the Med­ical Advi­so­ry Sec­re­tari­at at Health Qual­i­ty Ontario.

For more infor­ma­tion, please con­tact:

Jim Old­field
Uni­ver­si­ty of Toron­to Temer­ty Temer­ty Fac­ul­ty of Med­i­cine