Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept

STUDY DESIGN: Retrospective chart analyses as part of a quality improvement project. OBJECTIVES: To demonstrate treatment of pressure injury (PI) in patients with spinal cord injuries (SCI) and analyse costs using the “modified Basel Decubitus Concept”. SETTING: Inpatient setting of a specialised acute care and rehabilitation clinic for SCI. METHODS: Complex treatment courses of four patients with chronic SCI and PI stage III or IV were described and costs were recorded. The total healthcare services’ costs per patient and different profession’s involvement were analysed in relation to patient characteristics, treatment phases and milestones demonstrated. RESULTS: The treatment of PI stage III and IV in patients with SCI included input from plastic surgery, rehabilitation medicine, nursing and other involved professions. Recommended interventions were chosen according to the “modified Basel Decubitus Concept”. The cost course of PI treatment in patients with SCI depicted the multimodal treatment concept, including three clinically and financially relevant milestones (debridement, flap surgery and mobilisation to wheelchair) as well as the highest costs in the functionally highly dependent patient. Acute care and rehabilitation overlapped with different intensities during the whole treatment process. CONCLUSION: Multimodal treatment concepts connecting acute and rehabilitation care were applied in these complex health conditions. Cost-explication models including treatment phases and milestones helped to understand resources more easily and integrate aspects of process-based management and quality of care. Scientific evidence is needed to create a recommended quality standard in line with adequate financing of this health condition.