Each year, as many as 1 million patients are injured in a fall in U.S. hospitals, making it the most common health-care-acquired condition, according to the federal Agency for Healthcare Research and Quality. Nearly half of those falls result in an injury.
The consequences of patient falls are enormous, affecting patients’ health, length of hospital stay, costs, patient satisfaction and staff morale. The most recent national data available, from 2010, show direct costs of patient falls in the U.S. totaled $30 billion.
The many elements associated with falls make them complex to prevent. Patient factors include weak muscles, chronic conditions and use of a cane or walker. Environmental factors include placement of medical equipment, bed height and items being out of a patient’s reach.
The study builds on a Lean Six Sigma Green Belt project by Susan Mascioli, MS, BSN, RN, CPHQ, NEA-BC, director of nursing quality and safety, and Janet Cunningham, MHA, RN, NE-BC, CENP, vice president of professional excellence and associate chief nursing officer. With co-author Jennifer Goldsack, MChem, MA, MS, a research associate at Christiana Care’s Value Institute, the study aligns with Christiana Care’s organization-wide commitment to prevent falls and create a culture of safety. It also demonstrates the successful partnership between Nursing and the Value Institute.
“We chose to focus on reducing falls in a more scientific way, utilizing Lean Six Sigma methodology to take a different approach to address a challenging and chronic problem,” said Cunningham. “While we believe we typically have best practices in place, the lesson learned is to match the solution to the specific patient population.”
The initial goal of the study was to reduce patient falls by 30 percent — to improve to a rate of 3.4 falls per 1,000 inpatient days from the 2012 baseline rate of 4.8 — on three patient care units 5D, 6C and 6E. The Center for Organizational Excellence at the Value Institute guided a multidisciplinary team using the Lean Six Sigma method and data-driven, patient-focused analysis to make significant findings, including:
• 89 percent of patients said they didn’t feel at risk for falling, whether they were at a low risk or high risk for falls.
• 40 percent of falls happened during changes of shift.
• 70 percent of patients were receiving medications that put them at risk prior to falling.
The study also identified the need for a strong partnership between staff and patients to prevent falls.
“Our staff are very concerned about patient harm and are really focused on preventing patient falls,” said Mascioli. “Their practice was to implement a number of different strategies which weren’t all necessarily aligned with the specific patient’s fall risk factors.”
Guided by change-management experts and the Lean Six Sigma framework, the Christiana Hospital staff participating in the study gained valuable insight to help them understand the root causes of falls and better target their improvement efforts.
The team piloted three different strategies based on the units’ patient populations. These strategies were patient-centered hourly rounding, verbally communicating patients’ fall risks at handoff during shift change, and mobility assessments.
In the course of a year, the combined fall rate had improved more than 52 percent on the three units — medical units 6E and 5D as well as 6C, the Stroke Treatment and Recovery Unit. Those three units were then paired with other units at Christiana Hospital, which yielded more successes. The staff on the patient care units participating in this project and those paired units worked diligently to understand the root causes of their patient falls and implement successful fall prevention strategies.
The Christiana Care study is timely. Beginning Oct. 1, the Centers for Medicare and Medicaid Services began imposing a 1 percent cut in Medicare reimbursement for all discharges on organizations with high rates of hospital-acquired conditions, including patient falls.
The research also is gaining prominence, with the Christiana Care team giving a 75-minute podium presentation in September at the National Association of Healthcare Quality, which focuses on advancing the profession of health care quality and patient safety.
Upcoming articles look at patient perceptions of falls and the most successful strategy: patient-centered hourly rounding.
The team plans to continue to share its findings and falls-prevention efforts throughout the health care industry to help educate more of the nation’s hospitals on how they can protect their patients from falls.
“This is an opportunity to take a problem that is persistent and pervasive, one that was really challenging for patients and our staff, and find some answers that are both successful and sustainable,” said Goldsack. “If we’re able to spread this concept, both internally and externally, I think we’ve set up a model to address all sorts of health care challenges.”