NUR 684 Module 8 Business Case Paper Example

The Business Case for a Heel Pressure Injury Prevention Bundle

[Student Name]

Southern New Hampshire University

NUR 684: Clinical Nurse Leader Capstone

Module Eight Business Case Paper

[Instructor Name]

[Date]

The Business Case for a Heel Pressure Injury Prevention Bundle

Clinical leaders often assume that preventing harm justifies itself. Hospital leaders must weigh every request against others, and a clinical nurse leader who can present costs, savings and uncertainty clearly is more likely to secure support and keep it. This paper makes the business case for the heel pressure injury bundle on Clearwater General's orthopedic floor. It reviews what published economic studies show, builds a budget for the unit, estimates the savings from avoided injuries, calculates a break-even point and tests how sensitive the result is to key assumptions.

The Cost of the Problem

Lyder et al. (2012) found in a national Medicare sample that patients who developed a pressure injury in the hospital had longer stays, higher readmission rates and higher mortality than comparable patients who did not. Each of these outcomes carries cost: extra days in a bed that could serve another patient, repeat admissions that may bring payment penalties and the resources of wound care, specialty support surfaces and sometimes surgery. Injuries of stage 3 or 4 acquired in the hospital are also reportable and no longer attract higher Medicare payment, so the hospital bears their cost.

The hospital's finance office estimates the average added cost of a stage 2 injury on the unit at about $8,000, mostly from extra days, and considerably more for deeper injuries. These figures are internal and illustrative for this composite hospital, but they give the case a local anchor. Based on survey prevalence and skin round findings, the unit is estimated to generate about 20 hospital-acquired injuries of stage 2 or worse a year, most of them heels in hip fracture patients.

What Economic Studies Show

Padula et al. (2011) built a model comparing hospital pressure injury prevention programs with standard care over a patient's stay and beyond. Prevention programs improved outcomes at lower or acceptable cost in most scenarios, and in many they saved money outright, because the cost of treating injuries, especially deeper ones, outweighed the cost of prevention.

Whitty et al. (2017) costed the INTACT trial's patient-centered bundle using data gathered during that trial. They found that the bundle was likely to reduce costs and injuries together, although the uncertainty was considerable because the trial's clinical effect was not statistically significant. Their work is a useful caution: the economic case depends on the bundle working, and the bundle works only if it is delivered.

The Unit Budget

The bundle's yearly costs appear in Table 1. The largest items are heel boots for about 550 hip fracture patients a year and a small amount of protected time for champions. Training is brief, and skin rounds fall within the CNL's existing role. The emergency department's arrival check uses pillows already stocked.

Table 1. Annual Bundle Costs (Illustrative)

Note. Figures are illustrative for the composite hospital.

Savings and Break-Even

If the bundle prevents eight of the unit's estimated 20 injuries a year, a reduction of 40%, the avoided costs would be about $64,000 at the finance office's estimate, roughly double the bundle's cost. The break-even point is four avoided stage 2 injuries a year, a 20% reduction. Preventing even one deeper injury would offset a large share of the annual cost. These figures do not count harder-to-price benefits, such as faster mobilization after surgery, fewer painful dressing changes, staff time saved on wound care and the hospital's reputation on publicly reported measures.

Sensitivity Analysis

Because the estimates are uncertain, the case is tested under less favorable assumptions. If the added cost per injury were only $5,000, break-even would rise to about seven avoided injuries a year. If boot costs rose to $50 each, total costs would reach about $40,000 and break-even would require five avoided injuries at $8,000 each. If the bundle reduced injuries by only 10%, it would not pay for itself on direct costs alone, though it would still reduce harm. The analysis shows that the case is strongest if the bundle is delivered faithfully, which is why the implementation plan measures all-or-none completion. It also suggests a practical saving: boots could be reserved for hip fracture patients and those scoring 14 or below, with pillows used for moderate risk, cutting boot costs by about a third.

Value Beyond the Budget

Some benefits do not fit neatly in a spreadsheet but matter to leaders. Patients who avoid a heel wound can walk sooner, which supports the surgical team's goals for early mobilization and discharge to home rather than to a rehabilitation facility. Families notice when a parent returns from the hospital with a new wound, and that experience shapes how the hospital is judged in surveys and in the community. Nurses spend less time on dressing changes and documentation for wounds that should not exist, time they can return to other patients. And the project builds a working model of lateral, data-driven improvement on the unit that can be reused for the next problem, whether falls, delirium or catheter use. These benefits are presented as supporting points, not as the basis of the financial case.

Presenting the Case

The CNL and the nurse manager will present a two-page summary to the director of surgical services and the finance partner: the problem in patients' terms, the cost in the hospital's terms, the budget, the break-even point, the sensitivity analysis and a request to fund boots and champion time for one year with a review at six months. Framing the request as a time-limited test with clear measures makes it easier to approve and easier to stop if results disappoint.

Conclusion

The heel bundle costs about $32,000 a year and breaks even at four avoided injuries, a modest target against published evidence. The business case is sound if the bundle is delivered well, and the project's measures will show whether it is.

References

Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, D. R. (2012). Hospital-acquired pressure ulcers: Results from the national Medicare Patient Safety Monitoring System study. Journal of the American Geriatrics Society, 60(9), 1603-1608. https://doi.org/10.1111/j.1532-5415.2012.04106.x

Padula, W. V., Mishra, M. K., Makic, M. B. F., & Sullivan, P. W. (2011). Improving the quality of pressure ulcer care with prevention: A cost-effectiveness analysis. Medical Care, 49(4), 385-392. https://doi.org/10.1097/MLR.0b013e31820292b3

Whitty, J. A., McInnes, E., Bucknall, T., Webster, J., Gillespie, B. M., Banks, M., Thalib, L., Wallis, M., Cumsille, J., Roberts, S., & Chaboyer, W. (2017). The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial. International Journal of Nursing Studies, 75, 35-42. https://doi.org/10.1016/j.ijnurstu.2017.06.014