Preventing falls curbs costs and risk

With an annual rate of 11,000 fatalities from falls in U.S. hospitals, falls are a persistent concern for healthcare facilities. They raise issues of care quality and are increasingly a financial issue, as payers look for opportunities to cut reimbursements for long hospital stays. Thirty-five percent of patients who fall add about six extra days to their stay.

The Joint Commission Center for Transforming Healthcare, in partnership with seven hospitals throughout the country, set out to find causes and identify targeted solutions to prevent patient falls.

Using a method they call Robust Process Improvement, five participating hospitals were able to decrease the rate of falls with injury by 62 percent.

These results, said Erin DuPree, MD, chief medical officer and vice president of the center, surpass what has been achieved in collaboratives to date that have focused inpatient falls.

Falls are a complex problem. Overall, the collaborators found 30 root causes for falls leading to 21 targeted solutions. They also found that improvement strategies tend to be localized since the root causes vary from one hospital to another and even within different units of the same hospital.

Eileen Costantinou, practice specialist at Barnes Jewish Hospital in St. Louis, Mo. reports a successful project within the oncology unit, reducing the number of serious falls from four in one year to none over a period of 19 months. “We saved roughly $16,000 in operational costs for each fall with serious injury that was prevented.”

She stressed this was only related to acute care costs such as increased length of stay and diagnostic tests that the federal programs and most insurers will not reimburse for any more. The savings would be greater when other outlays such as rehabilitation care or lawsuits are included.

The findings show it is imperative for nurses to get to know patients and use critical thinking to understand the complexities of their risk for falling. Using this understanding to communicate with patients helps form trust and a partnership to achieve cooperation and prevent falls.

“Documenting that the patient has been told to call for help and has been given the instruction and interventions is huge from a risk management standpoint,” said Laurie Wolf, human factors engineer in the operational excellence department at Barnes Jewish. “If after all of the teaching and warnings, they still get up and fall, less of the liability for their actions will fall on the hospital.”

The savings of fall prevention can have a substantial impact on a hospital’s bottom line.

“Given the rate of inpatient falls at a typical hospital in this country, a 200-bed hospital could anticipate 358 falls leading to 117 injuries and associated costs of $1.7 million dollars each year,” said DuPree. “Using the Robust approach, though, you can expect 72 fewer injuries and $1 million in costs avoided. Although we did not address this issue directly, a reduction of legal fees could also contribute to savings.”