Therapeutic Support Surfaces across the Continuum of Care

Karen Egli, BA, RN, CWCN

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 contact.”4
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 care approach5 . Also, “Continuous preventative care of HAPIs in acutely ill patients could potentially reduce incidence and prevalence as well as lead to lower expenditures.”4

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 mobility.
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 .

Decisions, Decisions: 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 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, patient-centered solution.

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.

  1. Decreased rates of pressure injuries linked to better preventive care. December 15, 2016. Wolters Kluwer Health: Lippincott Williams and Wilkins. https://www.
  2. Preventing Pressure Ulcers in Hospitals. Are we ready for this change? Agency for Healthcare and Research Quality, AHRQ. 2014. professionals/systems/hospital/pressureulcertoolkit/putool1.html
  3. NPUAP. 2007. National Pressure Ulcer Advisory Panel Support Surface Standards Initiative-Terms and Definitions Related to Support Surfaces.
  4. Woo, KY., Effective Support Surface Selection: in Preventing and Treating Pressure Ulcers. Kestral Health Information, Inc. 2013/2018.
  5. Padula, WV, Mishra MK, Makic MB, Sullivan PW. Improving the quality of pressure ulcer care with prevention: A cost-effectiveness analysis. Med Care. 2011; 49(4):385-92.
  6. Wound Care and Support Surfaces. Jul 01, 2006 articles/2006/07/01/wound-care-and-support-surfaces.aspx
  7. Evaluation of Pressure Reducing Support Surfaces for the Treatment and Prevention of Pressure Ulcers and Promoting Comfort. Summary of 2009 study. Amato, PB.
  8. Support Surfaces- Product Selection. Swezey, L., August 16, 2012.