Patient falls, a source of serious injuries and spiraling hospital costs, are about to knock the wind out of healthcare budgets. A 2008 Medicare rule about to come online will eliminates payment for the cost of treating preventable in-hospital falls. That's a blow to any hospital, but smaller facilities could be floored by having those payments withheld.
While many efforts have been made to reduce in-patient falls, it's been a tough nut to crack. "The problem is that most hospital patients are moderate fall risks. We can't find a magic prediction rule that appears to discriminate between people falling and people who fall and injure themselves," says Ronald I. Shorr, MD, director of the Geriatric Research Education and Clinical Center at the Malcom Randall VA Medical Center and professor at the University of Florida Department of Aging and Geriatric Research, both in Gainesville, FL. Shorr was interviewed in the October issue of HealthLeaders magazine.
To be sure, there is no magic involved, but the results of a randomized trial suggest that the use of a fall prevention tool kit (FPTK) can significantly reduce the rate of what researchers rather stiffly called "unplanned descent to the floor during the course of a hospital stay." The study, Fall Prevention in Acute Care Hospitals, is published in Wednesday's JAMA.
In what may be the first instance of health information technology being used for fall prevention purposes, the FPTK included:
- A decision-support software application for use at the bedside
- An over-bed poster
- A patient/family education handout
- A plan of care
Conducted at four Massachusetts hospitals, including one community teaching hospital, the goal of the study was to determine if FPTKs could prevent falls. Through the use of icons and plain-language alerts, fall risk was communicated to 5,104 patients over a six-month period. Of the 11 icons used to communicate fall risk, eight were related either directly to toileting or getting out of bed to toilet.
"Bedside alerts that communicate safe toileting strategies tailored to the needs of individual patients are particularly important for preventing falls in older adults, in whom toileting-related falls are most common and more likely to result in injury," the study notes.
Of the 5104 patients observed in the study, in the end, there were 67 falls among patients exposed to FPTKs and 87 falls among patients in the units without the kits. Researchers calculated that the kits could potentially prevent one fall every four days, 7.5 falls each month, and about 90 falls each year in the study units alone.
While the results showed success in reducing falls in patients over the age of 65, curiously, the overall fall rate increased in patients younger than 65, indicating that different messaging may be required for this group.
See Also:
Reducing In-Hospital Patient Falls
Reducing the Patient Fall Rate in a Rural Health System
Fear of Falling Can Lead to Falls, Researchers Conclude
Elderly Fall Injuries Cost $20 Billion in 2006 and Price Is Rising