Background
72 Sacral & Heel HAPIs Per Year — Reduced to ZERO Across 4 ICUs
In a large urban academic medical center, hospital-acquired pressure injuries (HAPIs) in the critical care units had increased over several years despite layered quality initiatives. Baseline data showed 72 sacral and heel HAPIs annually across four ICUs, an average of 6 HAPIs per month.
Quarterly hospital-wide prevalence surveys identified that 67% of critical care patients had dark skin tones, a population with 60% greater risk of developing a pressure injury, increased risk of higher-stage injuries, and 4x higher mortality rates from pressure injuries. Visual skin assessment (VSA) and the Braden Scale were subjective and limited across racially diverse skin tones. Integration of the Provizio® SEM Scanner was proposed as an evidence-based strategy to reach the organization’s Zero Harm goal.
Methodology
Prevention Requires Early Detection. Early Detection Requires SEM Scanning.
The WOC team first deployed the Provizio SEM Scanner across all four critical care units following a successful 2-week clinical trial. The sacrum and heels are assessed each shift using the SEM Scanner, with elevated SEM deltas (≥0.6) triggering targeted pressure injury prevention interventions per the facility’s SEM scanning protocol.
Phase 1: Trial & Launch
- 2-week clinical trial across MICU A, MICU B, SNICU
- Full deployment across 4 critical care units
- EPIC EHR flowsheet updated with SEM scan fields and rationale codes
Phase 2: Scale & Sustain
- Fixed-head scanner trial in SNICU
- Usage expanded to one scanner per ICU patient room
- Ongoing WOC team education and compliance auditing by nurse managers
Results Achieved
2-Year Result
100% Zero Harm
All 4 ICUs reported zero sacral/heel HAPIs in Sept 2025 prevalence survey — first time in 20+ years
2-Year Result
40% HAPI Reduction
Sacral & heel HAPIs across 4 ICUs, Oct 2024–Sept 2025 vs. baseline year
2-Year Result
28 HAPIs Avoided
Most recent 12 months vs. baseline: 72 → 44 sacral/heel HAPIs
Annualized Impact*
$609,476 Treatment Costs Avoided
28 HAPIs × $21,767 per AHRQ benchmark
Annualized Impact*
112 Bed Days Released
~4 incremental bed-days per HAPI avoided
Annualized Impact*
$413,056 Bed Day Savings
112 bed-days × $3,688 per AHRQ benchmark
Conclusion
ZERO HAPIs Across 4 ICUs — First Time in Over 20 Years
Integrating SEM-guided assessment into routine ICU nursing practice eliminated sacral and heel HAPIs in the most recent hospital-wide prevalence survey and drove a 40% reduction over two years — across a patient population with elevated PI risk and documented skin-tone limitations in visual assessment.
Why These HAPI Reduction Outcomes Matter
Zero HAPIs across 4 ICUs is a 20-year clinical milestone in the organization’s highest-risk population.
- Protects high-risk patients — including the 67% dark-tone skin population — from a painful, preventable injury with 4x mortality risk.
- Restores nurse capacity previously absorbed by HAPI treatment, documentation, and downstream complications.
- Establishes a defensible, evidence-based standard of care for assessing racially diverse skin tones.
Early SEM detection estimated to avoid ~$1.02M annually in combined treatment and bed-day costs.
- $609K in treatment cost avoidance and $413K in bed-day capacity can be redeployed to higher-acuity admissions.
- Reduces exposure to CMS nonpayment, HAC Reduction Program penalties, and HAPI-related litigation.
- Strengthens regulatory survey readiness, quality scoring, and Magnet-level nursing reputation.