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Every year, hospital-acquired pressure ulcers and injuries (HAPU/I) across the United States result in significant patient harm, including pain, expensive treatments, increased length of institutional stay and, in some patients, premature mortality. Each year, more than 2.5 million patients in U.S. acute-care facilities are estimated to suffer from pressure ulcers and injuries, and 60,000 die from their complications.

The Joint Commission Center for Transforming Healthcare has collaborated with teams at The Johns Hopkins Hospital, Kaiser Permanente South Sacramento Hospital and Memorial Hermann Southeast Hospital to identify root causes of such injuries and solutions for reducing HAPU/I rates.

Through the “Reducing hospital-acquired pressure injuries” project, the hospitals will work with a Center for Transforming Healthcare team to apply Robust Process Improvement (RPI) to measure HAPU/I incidences at their organizations and analyze the root causes. Teams will then test and implement targeted solutions to address their unique root causes.

Following the project’s completion in summer 2019, the Center for Transforming Healthcare will analyze findings to determine whether targeted solutions identified and tested by the three participating hospitals can be replicated at other organizations.

The Agency for Healthcare Research and Quality found that HAPU/I rates have risen by 10 percent from 2014-2016 despite an 8 percent decrease in all other hospital-acquired conditions during the same time period. Additionally, the cost of treating a single pressure ulcer/injury can reach $70,000—leading to an estimated cost of $11 billion for treating pressure ulcers/injuries in the United States every year.

“Health care’s toughest problems to tackle are those with myriad root causes and widespread impact on patients and the entire industry such as a lack of consistent handwashing among hospital staff and the rising rate of hospital-acquired pressure ulcers/injuries,” said Klaus Nether, D.H.Sc., MMI, MT (ASCP) SV, executive director, High Reliability Product Delivery, The Joint Commission Center for Transforming Healthcare. “These are complex health care problems that require very specific targeted solutions due to their multiple root causes. As a result, each root cause requires its own strategy for improvement, and the set of root causes differ from one organization to the next.”

“I commend the teams at The Johns Hopkins Hospital, Kaiser Permanente and Memorial Hermann for their commitment to working with us to identify and test solutions that hopefully will benefit millions of patients across the country—and ultimately help hospitals attain zero harm in their delivery of care.”

Since its inception in 2008, the Center for Transforming Healthcare has led projects with teams from hospitals and medical centers across the United States to identify solutions to some of health care’s greatest patient care challenges.

The project is part of the Center’s mission to help transform health care into a high-reliability industry by developing highly effective, durable solutions to health care’s most critical safety and quality problems in collaboration with health care organizations.

For more information, visit the Center for Transforming Healthcare website at



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