Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database.
Susan A Kayser, Kimberly Koloms, Angela Murray and 2 others
PMID 34781311WHAT IT FOUND
Hospital patients coded with incontinence had longer stays, more readmissions, higher costs, and more sacral pressure injuries than continent patients.
Coded IAD treatment marked an even higher-risk group. Low coded rates likely underreport true burden.
Key findings
01Among 15,793,765 patients, 235,141 had an incontinence code (1.5%), and 1,602 had IAD treatment charges (0.7%).
02Incontinent patients had longer average length of stay (6.4 vs 4.4 days), higher readmission (12% vs 8.8%), higher average index cost ($17,020 vs $13,713), and more sacral pressure injuries (4.7% vs 1.0% on admission; 0.59% vs 0.12% hospital acquired) than continent patients.
03Incontinent patients with IAD treatment had longer average length of stay (9.7 vs 6.4 days), higher readmission (16% vs 12%), higher average index cost ($22,832 vs $16,981), and more sacral pressure injuries (10.9% vs 4.6% on admission; 1.2% vs 0.59% hospital acquired) than incontinent patients without IAD treatment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used administrative hospital records, so it could not determine whether incontinence or IAD treatment caused the longer stays, higher costs, readmissions, or pressure injuries. Incontinence was identified only through ICD-10-CM codes, and IAD treatment only through billed products, so the reported rates likely undercount patients with either condition. Patients with IAD treatment were identified by charges for skin cleansers, protectants, or wipes, not by a clinical diagnosis, so patients treated with soap and water or other uncharged care may have been missed. Readmission and cost after discharge were captured only if the patient returned to the same hospital, so some events may have been missed. The hospitals were those submitting data to Premier, which may not represent all US hospitals.
Declared interests
The article reports no outside funding for the research.
The easy way to misread this
Do not conclude that IAD products caused longer stays, higher costs, or more pressure injuries. This is a retrospective database analysis, and patients with billed IAD treatment were also more likely to be fecally or dually incontinent, immobile, cognitively impaired, and had higher comorbidity scores.