I've spent my career in nursing, and there are problems that keep me up at night. Hospital acquired pressure injuries (HAPIs) are near the top of that list. Not because they're mysterious. Not because we lack the tools or the knowledge to address them. They keep me up at night because the solution is often already inside the hospital — and no one is connecting the dots.
Here's the frustrating reality playing out in hospitals across the country: a facility invests in a sophisticated outpatient wound center. They have advanced practice clinicians. They have evidence-based protocols, specialized dressings, hyperbaric capability, and complex wound expertise. They are — by every clinical measure — a center of excellence for wound care. And down the hall, on the inpatient floors, patients are developing pressure injuries that could have been prevented.
The expertise exists. The resources exist. The gap between them exists almost entirely because of the way wound care management has been structured — and who profits from keeping those two worlds separate.
Many hospital outpatient wound centers operate under management contracts with large wound care management companies. Those companies are very good at what they do in the outpatient setting. That's their revenue model. That's where their attention goes. When a hospital then asks about inpatient wound care support — education for floor nurses, 7-day clinical coverage, HAPI prevention protocols — the management company is often willing to help. For an additional fee. Sometimes a significant one.
The message, however unintentional, is this: inpatient wound care support is a separate service you'll need to purchase. It is not part of the partnership. At Wound Care Advantage, we believe that is fundamentally the wrong approach — clinically and operationally. And we've proven there's a better way.
Before I describe our approach, let me describe what I've seen in hospitals navigating this challenge without adequate support. It's important to name these realities plainly.
The understaffed wound care nurse. A single specialized wound care nurse, three or four days a week, responsible for hundreds of beds. She is talented. She is committed. She is completely overwhelmed. Referrals arrive late — sometimes after the patient has already been discharged. The patients who need her the most are the ones she never had a chance to see.
The Friday afternoon admission. A patient arrives through the ED on a Friday evening with a wound — or a skin condition that will become one. A dressing is applied. The patient is moved to a floor room. Saturday passes. Sunday passes. By Monday morning, that wound belongs to the hospital. The hospital owns the responsibility, the cost, and the care outcome — for a wound it never had a meaningful chance to assess.
The nurse who doesn't open the dressing. This is not a criticism — it is a system failure. Floor nurses who have not been trained in wound assessment are sometimes hesitant to remove a dressing without knowing what they'll find, or what to do when they find it. So the dressing stays. The wound progresses. The window for early intervention closes.
The data nobody sees. Documentation systems that are cumbersome, inconsistent, or disconnected from reporting make it nearly impossible to identify patterns, track outcomes, or demonstrate improvement. If you can't see the problem clearly, you cannot fix it systematically.
Each of these scenarios is preventable. None of them requires a new vendor or a new contract. They require integration, education, coverage, and commitment.
Wound Care Advantage has developed an inpatient wound care integration model built specifically around the hospital partnerships we manage on the outpatient side. We do not offer it as a separate billable service — it is built into the structure of our management partnership, because we believe a wound care company that charges extra to care for the whole patient is not actually a partner. It’s a vendor. This is part of what we believe a true wound care partnership should include.
The model has four pillars:
1. Program Integration. The outpatient wound center and the inpatient wound care program must operate as a single clinical continuum — not as two separate entities with different teams, different protocols, and different goals. When the intelligence and expertise of your outpatient program flows into the inpatient environment, and clinical culture begins to shift.
2. Organization-Wide Education. HAPI prevention cannot live inside the wound care team alone. It must live in every unit, every shift, every nursing orientation. That means structured education for floor nurses on assessment, documentation, escalation, and early intervention. It means building confidence at the bedside, not just in the specialty clinic.
3. Intelligent Documentation. Easy-to-use documentation and reporting systems that enable real-time visibility into wound status, referral timeliness, HAPI incidence, and outcomes. Data drives accountability. Accountability drives improvement.
4. Seven-Day Coverage. This is non-negotiable. Wounds do not respect business hours. Weekend admissions, holiday arrivals, and Friday afternoon transfers cannot be left to wait for Monday morning. In our model, seven-day coverage means wound-trained clinical resource — an actual person, on-site and available — every day of the week. That may look different depending on facility size and acuity, but the standard is the same: no patient developing or at risk for a pressure injury should go unassessed for 48 or 72 hours simply because it’s the weekend.
I am proud to share that a 158-bed acute care hospital we partner with came to us with a reportable HAPI rate of 20%. That is not a typo. Twenty percent.
“Reportable” here means what CMS defines as non-reimbursable hospital-acquired pressure injuries: stage 3, stage 4, DTI and unstageable wounds — the ones that trigger payment denial and regulatory scrutiny.
Over the course of our partnership, applying this integrated model with full organizational commitment, that hospital has sustained a zero reportable HAPI rate for the past five years.
I want to be careful about how I present this. This is not a magic solution. It is not fast or simple. It requires serious organizational commitment, the willingness to navigate political complexity, and honest conversations about turf, coverage, cost, and culture. These challenges are real.
But they can be overcome. We know, because we've done it.
The financial stakes are not abstract. According to the Agency for Healthcare Research and Quality, pressure injuries affect more than 2.5 million patients annually in the U.S., contributing to an estimated $9-11 billion in annual healthcare costs. Since 2008, CMS has denied reimbursement for hospital-acquired Stage 3 and Stage 4 pressure injuries — a policy that made HAPI prevention not just a quality imperative, but a direct financial one.
The regulatory stakes are escalating further. Beginning January 1, 2027, the Joint Commission will align its Sentinel Event framework with the NQF Serious Reportable Events list. This means facility-acquired Stage 3, Stage 4, unstageable, and deep tissue pressure injuries that result in serious harm will carry formal sentinel event weight. This matters more than many clinicians realize: under current staging definitions, any wound exposing subcutaneous tissue with slough or granulation tissue qualifies as a Stage 3. “Serious harm” is defined broadly enough to include impairment of activities of daily living, major interventions (including debridement and NPWT), and significant psychological distress. While reporting remains voluntary, accredited organizations will be expected to conduct root cause analysis and demonstrate systemic improvement. A HAPI that once triggered a payment denial can now trigger a sentinel event review. This financial argument for HAPI prevention has always been compelling. The compliance argument just got significantly louder.
When HAPI rates drop, length of stay decreases. Infection risk decreases. Amputation risk decreases. Patient satisfaction improves. And many of those patients — once stabilized through inpatient care — can successfully transition to the outpatient wound center for ongoing management.
The ones who cannot — those discharged to skilled nursing facilities or other post-acute settings — should not fall off the clinical radar. Part of our mission is ensuring those patients are tracked and supported, and that pathways exist to bring them back into appropriate care when they're ready.
That is what a whole-patient wound care program looks like. That is the standard every hospital with a wound center should be held to.
If your hospital has an outpatient wound center managed by a company that charges extra for inpatient support — or worse, one that has never raised the conversation at all — I would invite you to ask a hard question: is that partnership serving your entire patient population, or only the ones who make it to the outpatient clinic?
At Wound Care Advantage, our model is built on the belief that inpatient and outpatient wound care are inseparable. The health of your patients doesn't stop at the clinic door, and neither does our responsibility to you. If you are facing challenges with HAPIs, with inpatient wound care coverage, or with translating your outpatient program's expertise to the floors where it's needed most, I'd welcome the conversation.
There is a better way. And it doesn't have to cost more.
Christina Le, MSHA, BSN, RN, CWS, WCC, OMS is the Chief Nursing Officer at Wound Care Advantage, the nation's leading hospital-independent wound care consulting and management company. WCA supports hospital networks and health systems in building high-performing, self-managed wound care programs. Learn more at thewca.com.
About Wound Care Advantage
Wound Care Advantage (WCA) is the nation's leading wound center consultancy, helping hospital networks optimize clinical outcomes, compliance, and profitability across their wound care and hyperbaric medicine programs. Founded 24 years ago on the mission that every community deserves access to advanced wound care and hyperbaric medicine, WCA has partnered with over 200 wound centers nationwide.
