Quality improvement initiatives are essential to meeting key national benchmarks when delivering care, and prevention of skin breakdown and pressure injuries is often one of the priority QI measures addressed. Failing to adequately address the risk of pressure injury has significant impact on patient safety ratings, quality outcomes, and creates serious financial implications due to the cost of treating hospital-acquired skin breakdown.

Because of this, hospitals and health systems put a great deal of focus on the selection of appropriate patient support surfaces to reduce pressure, shear, friction, and moisture for patients at high risk of skin breakdown.

However, despite these efforts, one source of pressure injuries and skin breakdown is often overlooked: stretcher mattresses. For true continuity of care for skin integrity throughout a hospital stay, every surface a patient may spend time on requires consideration. An organization’s choice of stretcher mattresses can have significant impact on pressure injury incidence, facility risk, and patient satisfaction. Therefore, it is critical to choose stretcher mattresses that help prevent both pressure and shearing.

A Hidden Challenge: Time Spent on Stretchers

It’s well understood by wound care specialists that pressure injuries can develop in as little as two hours. Older adults, those who are critically ill, incontinent, immobile, or have poor nutritional status are all at increased risk, and these people are the ones who require hospital care the most. While resting on a poorly designed surface, occlusion of blood flow to tissues and cell death begins quickly due to uneven distribution of pressure.

With as many as every 10th hospital patient having a pressure injury, the urgency of this threat starts as soon as a patient comes through the hospital doors. In many cases, that entry point is the emergency department (ED), where the primary hospital “bed” is in fact a stretcher.

In this context, the length of time a patient spends on a stretcher can be significant. Recently, the American College of Emergency Physicians (ACEP) highlighted a particular issue which they deem a “public health emergency”: ED boarding.

ED boarding is the practice of holding patients in the ED while they wait for an inpatient bed — many times in the ED hallways and crowded overflow or observation areas. In an ACEP poll, 44% of people reported that either they or a loved one had faced extended wait times in the ED, many as long as 13 hours. Sometimes, at the most extreme, these waits can stretch into days or even weeks.

A Hidden Challenge Time Spent on Stretchers

When a patient finally reaches that inpatient bed, the availability of an appropriate mattress usually reflects decisions made at an organizational level by a committee with representation from various areas of the organization, including clinical, risk management, infection control, procurement, environmental services, and bio-med.

But in the ED, stretcher mattresses may not have been afforded the same level of careful consideration. And by the time a patient reaches a proper support surface, it can be too late.

Additional time spent waiting on stretchers may also loom, even after admission to an inpatient bed. With healthcare staffing shortages creating delays in care, patients may find themselves resting on stretchers for an extended time in many scenarios:

  • While waiting for hospital transportation
  • In post-procedural areas
  • During radiology exams
  • During room-to-room transfers

The Hidden Danger of Transferring

It’s clear that stretchers should not be viewed as a short-term patient support solution that does not have potential to lead to pressure injuries. But what about patients that are only on a stretcher for a very brief time? These patients are quickly transferred to more supportive surfaces, which may create a false sense of security — but the reality is that a poorly designed stretcher mattress also increases the risk of pressure injury during transfers. These transfers can cause another problem: shearing.

Shearing is tissue damage caused by opposing forces of movement separating skin and deep tissue from each other. This can happen as patients shift or move on a poorly designed stretcher mattress, with increased risk during activities such as sliding across a stretcher during a transfer. This deep damage can develop into a more serious pressure injury, especially if the patient then experiences continued exposure to poorly distributed pressure on a poorly designed surface.

Each time a patient is moved from a stretcher to a bed and vice versa, the stretcher mattress is half of the equation in safely transferring the patient without shearing. If the bed has a properly designed mattress but the stretcher does not, patients are needlessly placed at risk.

How to Choose the Right Stretcher Mattress

Obviously, a standard stretcher mattress is not enough to reduce the risk of skin breakdown. The SPAN UltraMax™ stretcher surface, from Savaria Patient Care, addresses the risk of both pressure and shearing, helping to eliminate these dangers for patients who are placed on stretchers for any length of time and creating exceptional continuity of care for skin integrity across all support surfaces in a facility.

UMax for Stretcher cut flat

Features to Reduce Pressure

The UltraMax™ addresses pressure with Ultra High Performance Foam, a specialty foam product precision engineered to offer differing densities of support across the surface of the stretcher. This results in a level of restful comfort typically possible only on full-sized hospital bed surfaces. With a “three-dimensional zoning” design and 55% higher support factor in the seat section than traditional stretcher mattresses, it provides premium pressure redistribution.

Features to Reduce Shearing

Targeted design features inside and out of the UltraMax™ address shearing. This helps improve protection in two ways:

  • Inside the mattress, Geo-Matt® surface segmentation provides hundreds of individually articulating support cells to cradle bony prominences while channeling away heat and moisture build-up that can exacerbate risk of pressure injury
  • On the outside, the patented “Shear Transfer Zones” of the outer stretch cover help overcome the macro-shear, micro-shear, and rotational (pivot-induced) shearing that can occur with use of standard stretch covers

These features combine to provide additional support where it matters most: under bony prominences like the heels, sacrum, and scapula, and by preventing problems like “bottoming out” that can happen during transfers with standard stretchers, causing shear injury.

Additionally, the UltraMax™:

  • Has a standard depth of 5”, thicker than a traditional stretcher mattress
  • Is made in exclusively in North America
  • Has an extremely durable and cleanable bi-directional antimicrobial stretch cover that is resistant to fluids and chemical breakdown from bleach and disinfectants
  • Supports patients up to 700 lbs
  • Is 100% latex-free and 100% PBDE-free
  • Comes with a 3-year, non-prorated warranty

Exceptional Continuity of Care with the Right Stretcher Mattress

Stretcher mattresses are the first line of defense when it comes to protecting skin integrity in the hospital. Just like a high-quality bed mattress can guard against pressure and shear injuries, a high-quality stretcher mattress that helps eliminate these threats is essential.

By ensuring careful selection of a durable, innovative stretcher mattress like the SPAN GeoMattress® UltraMax, your quality initiatives, patient outcomes, and improved patient safety ratings are supported throughout the entirety of a patient’s hospital stay.

To learn more, get in touch with our experts today. We can help you ensure continuity of care across the spectrum of patient support surfaces.