Therapeutic Support Surfaces
across the Continuum of Care
Choosing the right therapeutic support surface for
a patient at risk for pressure injury (PI) is an area
where consistency must be maintained across the
patient care continuum. The prevalence of hospital-
(or facility) acquired pressure injuries (HAPIs/FAPIs)
in the US is approximately 9.3 percent2
. The cost of
patient care per PI can range from $20,900 to more
than $150,000 per occurrence, according to the
Agency of Healthcare Research and Quality (AHRQ)2
Patients with PIs are often affected physically by pain
and limited mobility and mentally by depression and
social isolation. PIs can also lead to increased lengths
of stay (LOS), higher costs, and patient mortality.
An Integral Part of the Care Plan
According to the National Pressure Ulcer Advisory
Panel (NPUAP), support surface selection is an
integral part of any care plan for the prevention
and treatment of PIs. The NPUAP defines support
surfaces as “specialized devices for pressure
redistribution designed for management of tissue
loads, microclimate, and/or other therapeutic
functions (i.e. any mattress, integrated bed system,
mattress replacement, overlay, or seat cushion, or
seat cushion overlay”)3.
Support surfaces prevent and/or treat PIs by
“facilitating pressure redistribution, removing
pressure to injury-prone areas, and spreading weight
evenly to avoid pressure buildup.” The effect of
pressure redistribution is “determined by the surface
area of the body in contact with the mattress; the
larger the area of the body that is supported by the
mattress, the lower the pressure at any given point of
There is significant literature that support surfaces
play a critical component in PI treatment and
prevention. Healthcare facilities must determine
how to use therapeutic surfaces in a cost-effective
manner that results in positive patient outcomes.
A cost-effective analysis, conducted by Padula et
al., was initiated to determine whether prevention
methods are cost-effective when compared with
standard care in the management of HAPIs. The
conclusion was that, although therapeutic surfaces
and other preventive measures add expense to
patient care, the number of preventable HAPIs
equates to approximately 1/40th of the standard
. Also, “Continuous preventative care
of HAPIs in acutely ill patients could potentially reduce incidence and prevalence as well as lead to
Choosing the Right Surface
When choosing a therapeutic support surface, it’s
important to consider how the surface’s features
match the patient’s health level. A decision tree or
algorithm can help facilities determine a surface
choice for an “at risk” patient.
Also remember that a patient’s therapy surface
needs may change as their overall health changes
and they transition from one care setting to the next.
In an acute care facility, units such as the Emergency
Department (ED), Operating Room (OR), and PostAnesthesia Care Unit (PACU) need high-quality foam
or air support surfaces. Patients may be immobile for
hours, be hemodynamically or medically unstable,
and skin concerns may be overlooked as other issues
take immediate priority.
ICUs and Med-Surg units must have effective
therapeutic surfaces ready for a variety of patient
care needs. Some ICU surfaces incorporate turning
technology to assist with pulmonary toileting,
while others focus on active pressure redistribution,
microclimate management and immersion for
managing fragile skin flaps and burns. As patients
transition to rehabilitation settings, support surfaces
in these areas must facilitate and encourage patient
Long-Term Acute Care (LTAC) and Long-Term Care
(LTC) facilities need many of the same types of
surfaces, but may also have additional regulatory
requirements and reimbursement challenges when
renting or purchasing support surfaces for their patients and residents. Across the continuum, it’s
important to know that a “support surface that is
reimbursed in the acute care setting may not be
in the home care arena.”6
Homecare and hospice
patients often require pressure-relieving support
surfaces specific to their needs—while also being
compatible to their settings. For hospice patients,
preventing skin breakdown may not be as important
as relieving pressure and providing comfort at the
end of life7
How Algorithms Create Consistent Care
Does your patient need rotation or immersion?
Alternation or pulsation? The Sizewise Clinical
Support Team works with facilities and units to
provide guidance on support surface selection
from a wide range of rental and capital options.
Custom algorithms are often developed in
collaboration with a facility’s wound care
team—and then deployed across units so
all staff can follow the same protocols, with
budget and contract limitations in mind.
Email firstname.lastname@example.org or ask
your Sizewise rep for more information.
Questions to Ask
Healthcare facilities have numerous considerations
when determining how to use support surfaces
within various settings. Will the product or variations
of the product be effective for the majority of needs?
How well does the surface function and perform?
Are patient outcomes optimal? Is the product
cost-effective and easy for staff to use? Are there
regulatory considerations? Additionally, they must
decide whether to rent or purchase. There are also
patient-specific factors regarding outcomes, safety,
comfort, and overall patient satisfaction. Facility
specific factors include issues of facility needs,
cost effectiveness, staff satisfaction, and whether
products are regulation-compliant.
Although it is challenging to provide value-based
quality in all healthcare settings, it is essential to
assess the support surfaces as patients transition
from one care setting to another. The best
outcomes happen when providers, facilities,
and vendors work together toward a healing,
The Right Surface for the Right Patient at the Right Time
Support surface needs change as a patient moves through the continuum of care.
The right support surface vendor can provide a range of capital and rental solutions
to follow the patient from the ED to Med-Surg to Post-Acute settings.
About the Authors
Karen Egli, BA, RN, CWCN
Karen Egli is a Clinical Liaison for Sizewise, a registered nurse, a
certified wound care nurse (CWCN), and a member of the National
Pressure Ulcer Advisory Panel’s Corporate Advisory Council.