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Abstract
Pressure ulcers, also known as pressure injuries (PI), are a common and serious complication of spinal cord injury (SCI). Impaired wound healing in SCI patients contributes to the progression of these ulcers to more severe stages, which are increasingly more difficult to manage. Best practice guidelines suggest that surgical reconstruction with a flap is an option for chronic stage IV PIs that have failed to heal with more conservative measures. However, little is known about the epidemiology of surgically reconstructed PIs in SCI patients. Despite efforts to select suitable patients for this procedure, the rate of surgical wound complications remains high and the cost of management is extensive. Accordingly, it is important to establish a systematic approach for identifying SCI patients with surgically reconstructed PIs to facilitate the study of predictors of sustained wound closure, quantify the cost of surgical reconstruction, and evaluate the efficiency of treatment and recovery options.
To address gaps in the literature, this study aimed to achieve four objectives: (1) To estimate the hospital costs of surgical reconstruction of stage IV PIs in SCI patients and characterize the relationship of demographics, socioeconomic status and lifestyle factors to cost at discharge from SMH, (2) To determine a standardized method of identifying cases of surgically reconstructed PIs in SCI patients from large databases, (3) To identify and validate risk factors for complications of surgical reconstructed stage IV PIs in SCI patients at discharge from SMH wound care follow-up and (4) to identify long term cost and health care utilization of persons with SCI who have undergone surgical flap closure at SMH in the ICES database.
About the Speaker
Laura Teague is has started working in her new role as Nurse-Practitioner-Clinical and Academic Lead for wound care at the Sinai Health System in Toronto, Ontario.
From 1987 to 2016, Laura worked in various clinical and leadership positions as a registered nurse, clinical nurse specialist and nurse practitioner – wound care at a teaching hospital in downtown Toronto. She lead and grew an interdisciplinary team to address wound prevention and treatment at this hospital. In the role of clinical nurse specialist and nurse practitioner, Laura lead annual hospital point prevalence studies for pressure injuries for 13 years. Results from these studies leveraged changes in practice, education, products, supply chain and devices to mitigate avoidable and unavoidable injury.
Laura’ passion for quality improvement and development of standards of practice has been driven through her experience in the wound prevention and treatment field. She has been directly involved with development of best practice guidelines through the RNAO. Laura has provided continuous leadership through development of the Ontario Woundcare Interest Group as the founding president and membership on the executive. Through this interest group, she lead 3 health technology assessment applications and one Ontario Drug Benefit review application. Laura also successfully negotiated an educational clinical institute focused on best practices in wound prevention and treatment with the RNAO, which is in its 11thyear.
Laura is currently completing her thesis in the PhD program at McMaster University, Faculty of Health Sciences, School of Nursing. Her thesis work involves a cohort study of spinal cord injured persons who have undergone surgical closure for pressure ulcers. This study is funded by the Ontario Neuro-trauma Foundation.
