St. Louis-based Ascension closed the disparity in severe hospital-acquired pressure injuries between patients with light and dark skin tones to 0% in fiscal 2026, the health system said Aug. 11.
The change followed a systemwide push to standardize skin-tone assessment at the bedside, an effort aimed at a long-documented blind spot in wound care.
Early pressure injuries present as redness or nonblanchable erythema, findings that are harder to see on dark skin. Missing a stage 1 injury risks it deepening into a stage 3-or-higher wound before intervention can take place. The 119-hospital system trained nurses to assess and document each patient’s skin tone — a check that goes beyond the standard visual scan, which can miss early damage on dark skin, according to an Ascension news release.
The result was a 38% reduction in stage 2 and stage 3-or-higher hospital-acquired pressure injuries and 444 cases prevented, according to what the system called a conservative estimate. It reported no outcome difference in severe injuries between light- and dark-skinned patients for the year.
The intervention grew out of Ascension’s research. In a study of 55,658 patients across acute and post-acute facilities — published in the November/December 2025 issue of Nursing Outlook and funded by Ascension Health — nurse investigators used the 10-point Monk Skin Tone Scale to measure pigmentation directly rather than relying on race as a proxy. Patients with medium-to-dark skin tones carried up to four times the risk of developing a more severe pressure injury than patients with lighter skin.
The elevated risk did not begin at the darkest tones. The study’s dividing line fell at Monk 06, a medium skin tone, where the proportion of injuries detected at the earliest stage fell sharply. That widens the problem to a larger group of patients than those with the darkest skin tones.
“Reducing systemic care gaps illustrates why nursing research is a vital clinical asset,” Cynthia LaFond, PhD, RN, senior director of nursing research at Ascension, said in the release.
The result speaks to a well-worn problem. Because early damage is harder to spot on dark skin, clinicians can miss it until a wound turns severe. Black patients develop higher-stage injuries than other groups, and U.S. researchers have tracked this disparity for decades. Yet, as the study authors noted, almost no prior studies measured skin tone, and formal guidance on assessing dark skin still rests on expert opinion alone.
Pressure injuries are among the most expensive preventable harms in U.S. hospitals. Treating them in acute care runs more than $27 billion a year, according to a study published in the International Wound Journal, and severe wounds can lead to sepsis and death.
The problem reaches beyond wound care. Optical tools such as pulse oximeters have drawn FDA scrutiny for reduced accuracy on darker skin, part of a broader recognition that devices and assessments were calibrated to light skin.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
