Award Date


Degree Type


Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

Advisor 1

Daniel Young

First Committee Member

Merrill Landers

Second Committee Member

Daniel Young

Number of Pages



Background and Purpose: Pressure injuries (PI) are prevalent and costly for hospitals. Hospitals implement different practices to accurately document PIs ranging from pen and paper to photodocumentation in electronic medical records (EMRs). In some instances, PIs that have been documented are not coded for billing and reporting. The purpose of this study is to determine if different documentation practices affect the number of coded PIs. Methods: Counts of coded PIs were collected from 2011- 2017 from two hospitals: a 500-bed acute care hospital (ACH) and a 42-bed acute rehabilitation hospital (ARH). A series of PI documentation practices were implemented over the course of the six years data were collected. The aim of the changes were to improve the accuracy of wound assessment, facilitate transparent and accurate reporting, and improve care. The four documentation practice time periods included 1) baseline, 2) PI photodocumentation with paper and all paper charting, 3) PI photodocumentation on paper and EMR for all other charting, and finally 4) all charting and documentation in the EMR. Results: In the 500-bed facility, a statistically significant difference was found in the mean number of PIs coded among the four documentation periods (F(3) = 45.460; p < 0.001), with the highest number of PI’s reported during PI photodocumentation with paper and all paper charting. In the ARH there was a statistically significant difference in the average number of PIs among the four different documentation periods (Period 1-ARH Mean = 56, Period 2-ARH Mean = 31, SD = 11.3, Period 3-ARH Mean = 36.1, SD = 14.4, Period 4-ARH Mean = 58.7, SD = 11.3; F(3) = 5.994; p = 0.006). In post hoc analysis a significant difference between Period 2-ARH and Period 4-ARH (p = 0.036), as well as between Period 3-ARH and Period 4-ARH (p = 0.005) was observed. Discussion: Changes in documentation practice coincided with significant changes in the number of PIs being coded in the ACH and ARH. Improper or inaccurate documentation of PIs has the potential to result in inaccurate coding and therefore missed payment for services provided. More serious PIs that are not coded properly may cost the facility thousands of dollars in missed payments. Accurate assessment and subsequent coding of PIs ensures the facility is fairly compensated for services provided.


Pressure ulcers; Pressure injury; Hospital acquired condition (HAC); Present on admission (POA); Medical coding; NE1 Wound Assessment Tool; Electronic medical records (EMR); Photodocumentation


Physical Therapy

File Format


File Size

311 Kb

Degree Grantor

University of Nevada, Las Vegas