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

Abstract

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.

Development and Implementation of a Computerized Decision Support Systems in the Interdisciplinary Treatment of Stage IV Pressure Injury in Patients with Spinal Cord Injury: A Real Life Two-Group Parallel Design

“…The Basel Decubitus Concept [25,26] had been de ned with the following ve main principles 1. pressure relief, 2. debridement, 3. treatment of risk factors, 4. ap surgery and 5. prevention of secondary complication. Single interventions such as nutritional and psychological counselling were rede ned and integrated into the Basel Decubitus Concept [27][28][29].…”

“…The treatment concept for PI includes interventions by paraplegiology, plastic surgery, infectious diseases, specialized acute and rehabilitation care, physical, occupational and nutrition therapy as well as psychotherapy [21,26,27,29].…”

“…The Basel Decubitus Concept is a historically developed treatment concept and includes different therapeutic elements like risk analysis, transfer training and evaluation of assistive devices, etcetera [21,[25][26][27][28]. Due to the complexity of this concept, implementation and adherence in the clinical setting remained di cult [18,21,26,29].…”

Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

“…The Basel Decubitus Approach is a set of principles for the treatment of PIs that has been developed over the past few decades. It includes different therapeutic elements, such as pressure relief; debridement; treatment of risk factors, such as anemia, renal failure, uncontrolled diabetes, and spasticity; flap surgery; prevention of early postsurgical complications and PI recurrence; transfer training; and re-evaluation of assistive devices [21,[25][26][27][28][29]. Due to the complexity of this treatment approach, its implementation and adherence in the clinical setting have been difficult [18,21,26,28,30].…”

Dekubitus: eine Herausforderung

“…Auf diese Art und Weise werden adäquate Antibiogramme angefertigt, und eine passende, systematische antimikrobielle Therapie kann begonnen werden. Sechs Kategorien/Stadien/Grade des Dekubitus.Eine Knochenbiopsie aus dem Ulkusareal hilft, eine begleitende Osteomyelitis zu diagnostizieren und zu behandeln[12].Zum therapeutischen Gesamtkonzept gehört auch eine Sanierung der Infekte des Urogenitaltraktes sowie der Atemwege. Eine unbehandelte Infektion der Harnwege kann zu einer konstanten Quelle einer Bakteriämie werden.…”