How One Rural Hospital Prevents Patient Falls

A small Illinois hospital comes up with a remarkably simple, inexpensive, and effective strategy to guard against falls and wins an award in the process.

By some estimates falls among older Americans cost about $30 billion in direct medical costs each year. That number may reach $55 billion in inflation-adjusted dollars by 2020 as the demographic ages and becomes more susceptible to falls.

Falls aren't cheap. Medicare estimates from 2002 placed the average cost per fall for "community-dwelling seniors" at between $9,113 and $13,507, making fall-related injuries one of the 20 most expensive medical conditions among that demographic.

The Agency for Healthcare Quality and Research estimates that in the U.S. between 700,000 and one million people fall within hospitals , resulting in fractures, lacerations, or internal bleeding and driving up costs. Citing research showing that about one-third of falls can be prevented, the Centers for Medicare & Medicaid Services in 2008 stopped reimbursing hospitals for treating certain traumatic injuries that occur because of falls.

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With so much at stake, many hospitals have made fall prevention a high priority over the last few years. Staff at Advocate Eureka Hospital, a 25-bed critical access hospital in Eureka, Ill., recognized they had a problem several years ago and created a program to examine hospital culture and preventive strategies around patient falls.

It's worked.

In 2009 the hospital had 15 patient falls. In 2011 it had 10 falls. In 2012 they had five falls. So far in 2013, the hospital has had just one patient fall, and has vaulted into the 10th percentile among best performing hospitals in its peer group, based on National Database Nursing Quality Indicators.

The dramatic turnaround has not gone unnoticed. Advocate Eureka was a winner of the Illinois Hospital Association Institute for Innovations in Care and Quality's 2013 Quality Excellence Achievement Award.

"Our patients tend to be elderly; 83%–85% of our population is Medicare patients and as a critical access hospital we have swing beds which are skilled nursing beds and more equivalent to a nursing home level of care. They tend to be elderly," says Jane McCully, RN, CPHQ, case manager/quality analyst Advocate Eureka. "There already is a fairly high percent of the population that just fall anyway at home and elsewhere just because of their age. We felt an obligation to do as much as we could to prevent that and protect them while they were in the hospital."

After the 15 falls in 2009, the staff at Eureka formed an interdisciplinary team to tackle the issue. "In 2009 that had been the highest it had ever been and there were a lot of factors that play into it," McCully says. "Three of those falls were the same patient who wouldn't oblige the fall prevention guidelines so there are factors like that internally that play into those numbers being higher. But that was still too high."

The strategy the group came up with was remarkably simple, inexpensive, and effective. At its core was a concerted and sustained effort to raise fall prevention awareness around the hospital.

"We called it All Hands on Deck and actually educated everybody in the hospital, even volunteers and housekeeping staff," McCully says. "People that might not have much patient contact but might be passing by a room and see a patient out of bed with their yellow socks on and knew that was not where they needed to be and they'd go and check with the nurse and tell her that the patient needed some assistance."

Other simple tactics included posting white board notices in patients' rooms assessing their fall risks and listing precautions. "It noted if the patient was a high risk or a standard risk for a fall, what their level of need was as far as what kind of equipment they needed to transfer from, say the bed to the toilet, whether they needed a walker or how many people needed to assist," McCully says. "Those things were hardwired into the white board on the wall so all the nurse or staff member had to do was circle what the precaution was that that patient needed."

The hospital also posted a "fall calendar" on its website marking the number of consecutive says since the last fall—which stood at 258 days when McCully and I spoke this week. "This was an obvious way to show that the staff was keeping track of these things and that they are making a difference," she says.

Patients are also made aware of fall risks. "We have a fall agreement that we use with patients where it is appropriate to bring them on board with what their plan is as far as fall prevention," McCully says.

"We want them to understand that we know you may not like to call for help because you are used to being independent. But you are in a hospital. Things are not the same here as they are at home and you need to let us help you when you get up to go to the bathroom or whatever. Nurses and staff members on the floor do a good job of educating them."

The common theme in all of these tactics is to raise awareness of the risks posed by falls, and to create an environment where everyone plays a role in preventing them. The good news is that these tactics can be done with very little financial stake, and the return on investment can be huge.

"This is one area where I feel like we have had success in hard-wiring these practices so that everybody is on board with what needs to be done to keep the patient safe from a fall," McCully says. "Sometimes we have so many things in healthcare that are in front of us all the time, that it is hard to always focus on some of the stuff that maybe is the most important. That has not been the case with this. It is something that everybody has embraced and taken their own accountability for their piece of making it happen. We did so many different things that spoke to different groups of people as this played out that I think we were able to make a real change."

McCully says she is not concerned about staff losing focus or feeling like the problem no longer exists as the number of falls has plummeted.

"With this particular issue, that hardwire change is there and I don't see that that is going to go away when we focus on something else," she says. "I am not saying we aren't going to have another fall ever, of course. But I don't see that the changes we've made are going to be transient. They are hardwired."