Dr Aaron Yeardley, Dr Nathan Wood and Dr William Beer from Tunley Environmental, and Dr Jane Fearnside and Kelly Phillips from Bassetlaw Teaching Hospitals NHS Foundation Trust, have written a white paper on the Pressure Ulcer Clinical Pathway Aid (PU-CPA), an AI-driven tool developed through the SBRI Healthcare programme. By integrating predictive analytics with clinical expertise, the PU-CPA supports personalised, evidence-based care pathways that optimise patient outcomes while reducing both costs and carbon emissions. Read the abstract and download the white paper below.
Pressure ulcers (Pus), also known as bedsores, are a major burden on healthcare as they cause distress, pain, and debilitation for patients while imposing substantial clinical, economic, and environmental burdens, (Fletcher et al,2021) affecting 4% to 10% of hospital patients in the UK (NICE, 2024). Management of one pressure ulcer costs between £1,214 and £14,108 (Dealey,et al, 2012), dependant on the category, equating to more than £3.8 million a day in the NHS (NHS Improvement, 2018) with the total estimated annual NHS cost of all wound management, including pressure ulcer, is £8.3 billion (Guest et al, 2020). Beyond financial costs, PUs contribute to prolonged hospital stays and increased medical supply use, elevating the carbon footprint of healthcare systems (Guest et al, 2020).
Current preventative and management strategies, such as repositioning and pressure- redistributing devices can face challenges in determining optimal care pathways that are truly personalised to the patient risk and needs. The Pressure Ulcer Clinical Pathway Aid (PU-CPA) tool, developed through the SBRI Healthcare programme, leverages predictive machine learning to provide data-driven recommendations for PU prevention and management. By focusing on our “3 C’s” - Care (patient outcomes), Cost (economic efficiency), and Carbon (environmental sustainability) - the PU-CPA tool aims to enhance personalised patient care, reduce healthcare costs, and promote sustainable practices. This article outlines the development and initial results of the PU-CPA tool, emphasising potential benefits to transform PU prevention and management.
Pressure ulcers are caused by prolonged pressure on the skin and underlying tissues, often affecting patients with limited mobility, poor nutrition, or comorbidities such as diabetes or vascular diseases (NICE, 2014). Pressure ulcers are in the ‘top ten harms’ in the NHS in England (Fletcher, 2022). Investigations into the causes of pressure ulcers frequently show that unwarranted variation from evidence-based practice contributes to the development of pressure ulcers. Pressure Ulcers are categorised through a skin assessment, and wound assessment to understand the layers of skin, location of bony prominences and whether there is any muscle or fat over the body structure (NWCSP, 2024). PUs are prevalent in 4% to 10% of UK hospital patients (NICE, 2024). Risk factors contributing to the development of pressure ulcers include immobility, poor nutrition, and comorbid conditions such as diabetes and vascular diseases (NICE, 2014). For patients, PUs are not only a clinical issue but also a source of significant distress, causing pain, discomfort, and messiness from exudate, which can severely impact quality of life and mental well-being (Qian et al, 2024). Debilitating effects may limit mobility and independence, prolonging recovery and increasing the risk of complications like infection (Qian et al, 2024).
The clinical and economic burden on healthcare systems is substantial. Direct costs related to treatment and hospitalisation are high, with estimates suggesting that treating a single pressure ulcer can cost between £1,214 and £14,108 (Dealey et al, 2012) (Indirect costs, such as loss of productivity and the need for long-term care, further exacerbate the financial strain on healthcare providers). Additionally, the environmental impact of pressure ulcers on the NHS is significant, with the treatment of pressure ulcers contributing to the consumption of resources and increased waste production. It is estimated that treating pressure ulcers costs the NHS more than £3.8 million every day, highlighting the need for sustainable practices in healthcare (NHS Improvement, 2018).