While families and patients seek out the best physicians and surgeons for medical procedures, no less important is the follow-up care that assures proper recovery. And optimal care requires not only great staff, but also the correct technology and tools to enable teams to do the best possible work. This article describes the challenge of patient falls, traditional approaches to fall prevention and how continuous monitoring technology can help nurses anticipate and limit the number of falls.
Falls and Their Costs
We've all experienced cases similar to this: "Donna" was recovering in bed following successful hip replacement surgery. Still under the influence of the anesthesia, she attempted to exit the bed to go the bathroom. She fell to the floor. The nurse ran in to respond, but the damage had been done. Donna was wheeled back into surgery to repair the new hip.
Over the course of my 32-year career, I've seen many patients sustain injuries as a result of falls. Each year, between 700,000 and 1 million patients fall in U.S. hospitals. More than 30% of these falls result in serious injury that requires further treatment.1 Falls are harmful to patient health and result in increased operational costs and financial penalties. They also impact how staff and families view the facility.
Studies show that the average cost associated with a serious fall-related injury is approximately $14,000.2 After a fall, patient length of stay (LOS) increases by more than 6 days.3 Not included in these statistics is the lost opportunity associated with additional days spent in recovery or the losses in potential revenue for hospitals as a result of longer LOS. Understanding the economics of this phenomenon is critical to appreciating the magnitude of the problem. This understanding enables us to make a strong case to healthcare executives who are concerned with a hospital's bottom line.
The Human Cost
Although the economic costs are important, nurses are more concerned with the effects on patient health and the dismay experienced when avoidable injuries occur. A "simple" fall in the hospital can have a lasting impact on a patient's quality of life and lengthen recovery significantly. Healthcare professionals feel obligated to deliver the best care possible and to work proactively to keep patients on track to better health. When a patient is injured on our watch, it is discouraging and stirs feelings of responsibility and failure.
Despite increased awareness in recent years, patient falls continue to be a serious challenge for the healthcare community. Bedside falls like the one "Donna" experienced are the most common type of fall and are mostly unwitnessed, limiting the ability of staff to respond.4
For this reason, hospitals have traditionally employed a variety of methods to limit falls. These include using pressure-based sensors, real-time video monitoring and increased staff check-ins to preempt patient needs. However, each of these methods has shortcomings. Pressure-based sensors only alert staff at the last second, so it is unlikely the fall can be prevented. Real-time video monitoring requires constant staff supervision and may impact patient and family privacy issues. Increased check-ins, while helpful, still mean that patients are unattended the majority of the time. They also require increased manpower-a difficulty given already restrained hospital budgets.
Continuous Monitoring Solutions
New technology is becoming available to enhance the ability to prevent falls or to respond to them more quickly. One option is in the form of contact-free continuous monitoring (CFCM). My facility, Reformed Church Home in Old Bridge, N.J., has been using a CFCM system for about 2 years.
In a CFCM, a sensor placed under the bed mattress continuously monitors patient heart rate, respiratory rate and motion. Real time data are relayed to the nurse workstation and smartphones to make the nursing staff aware of any changes that may require immediate attention. The sensor detects initial movement, which may be indicative of a patient trying to get out of the bed-thus providing advanced warning. This improves
SEE ALSO: Geriatric Head Trauma
According to published clinical studies, CFCM reduces the number of bedside falls by more than 40% and reduces hospital LOS by approximately 9%.5 This benefits both patients and hospitals and is critical for continued viability of our healthcare system. A recent Frost and Sullivan analysis noted that the most significant revenue generation opportunity from CFCM is in the expansion of current bed availability.5
CFCM can be easily integrated into department work flow. Our facility has experienced a significant reduction in the number of bedside falls-plus other benefits such as early detection of potential cardiac conditions and patient deterioration.
With tightening hospital budgets and greater responsibilities placed on nurses, now is the time to consider exploring new technologies to help improve patient safety, patient outcomes and the bottom line.
1. Pearson KB, Coburn AF. Evidence-based Falls Prevention in Critical Access Hospitals. December 2011. Policy Brief 24 from the Flex Monitoring Team. http://www.flexmonitoring.org/wp-content/uploads/2013/07/PolicyBrief24_Falls-Prevention.pdf
2. Wong C, et al. The cost of serious fall-related injuries at three midwestern hospitals. Jt Comm J Qual Patient Saf. 2011;37(2):81-87.
3. Galbraith J, et al. Cost analysis of a falls-prevention program in an orthopaedic setting. Clin Ortho Relat Res. 2011;469(12):3462-3468.
4. Australian Commission on Safety and Quality in Healthcare. Preventing falls and harm from falls in older people: best practice guidelines for Australian community care. Commonwealth of Australia, 2009. http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-COMM.pdf
5. Finding Top-Line Opportunities in a Bottom-Line Healthcare Market: Revenue Generation Opportunities Created by an Innovative Contact-Free Continuous Monitoring Solution. http://www.frost.com/sublib/display-market-insight.do?id=296601036
Grace Brunner is an adult-gerontology nurse practitioner at Reformed Church Home, a skilled nursing and assisted living facility in Old Bridge, N.J. She is also a clinical instructor and adjunct faculty member for Brookdale Community College.