Becker's Clinical Quality & Infection Control

39 Executive Briefing Sponsored by: Beyond Video Monitoring: Predictive Technology for Fall Prevention H ospitals face increasing pressure to improve quality, increase patient satisfaction and protect patients from adverse events. Reducing patient falls is an important way hospitals can achieve all of these goals; however, current practices — alert bracelets, bed alarms, side rails and restraints — have not provided a sustainable, effective solution to lower fall rates. Falls are among the leading causes of increased morbidity and mortality in hospitals and health systems, with at least 30 percent of these occurrences resulting in injury to the patient. Nearly 25,000 U.S. elderly died from injuries related to falls in 2013. Because falls typically necessitate additional medical attention, they also drive up the cost of care. A patient fall in a hospital averages nearly $14,000 in additional costs per patient stay. Expenditures resulting from patient falls topped $34 billion in 2013. The true cost of falls is even greater when accounting for the long-term costs of rehabilitation or ongoing care. Traditional reactive responses to patient falls are insufficient and more proactive measures are warranted. While the effect of falls on the healthcare system is divided into monetary and nonmonetary consequences, any negative outcome has the potential to increase the cost of healthcare through increased risk, poorer outcomes and lower patient satisfaction. Monetary and nonmonetary implications Patient falls can have both tangible and intangible costs to hos- pital systems. CMS does not pay for care rendered as a result of failure to keep patients safe, and the cost of falls to hospitals in- creases year over year. Since 2008, CMS has adjusted hospitals' reimbursement based on hospital-acquired condition rates, including falls and lowered reimbursement for low-performing hospitals. Two percent of the 35.1 million patient discharges per year experience a fall. This, combined with falls-adjusted reim- bursements, means hospitals face a serious payment deficit. It follows that an increase in liability and length of stay is immi- nent after a patient fall. Since no nationally reported decrease in falls has been realized, and the costs associated with falls are increasing, hospitals are in dire need of innovation and solutions that work. Some nonmonetary costs associated with patient falls, such as patients and families' loss of trust in the provider, translate to a financial risk via loss of business or referrals. Other indirect costs associated with patient falls are disability, loss of inde- pendence, psychological effects or increased anxiety related to embarrassment and fear of repeat falls, lost time from work or household duties, and decreased quality of life. Moreover, patient falls harm employee morale. Staff involved in a patient fall are at risk of experiencing guilt, frustration and decreased job satisfaction. Fall prevention challenges Strategies traditionally employed to reduce falls and their associated complications and costs have been limited to risk assessment tools, reaction-based alarms, human sitters, virtual sitters and video monitoring. Among the most widely used fall risk assessment tools are the Morse Fall Scale, Hendrich II, STRATIFY and the Johns Hopkins Fall Risk Assessment Tool. Altogether, there are more than 40 recognized fall risk assessment tools, the efficacy of which may be questionable since no real decrease in numbers of falls or associated costs have been realized over time. Moreover, these tools are frequently revised — an indication of their inability to predict risk and provide a false sense of security to healthcare workers. Alarms vary by type, but the most common are weight-depen- dent and personal alarms. Weight-dependent alarms include bed alarms, bed pads placed under the patient and floor pads that respond when the patient stands on them. Personal alarms are placed on the patient and are activated when a change in position breaches the limits of the distance a patient is allowed to travel. False alarms are one unanticipated consequence of alarm solu- tions. Staff must respond to multiple false alarms throughout a shift by physically going to the bedside to reset the alarms, adding to workload and increasing alert fatigue. Alarms are also ineffective at preventing falls since they don't sound until the patient is partially or completely out of bed. The window of opportunity for rescuing the patient is narrow, and as a result, these reactive devices have not reduced the overall number of patient falls in hospitals. Hospitals have resorted to providing constant observation as a measure to keep patients safe. However, human sitters involve labor costs associated with paid observers, and this fall reduction strategy is not linked to decreased length of stay for at-risk patients. Further, observers often have limited training and guidelines for their role as a sitter. The most appropriate sitter would be a registered nurse who could utilize critical thinking and individualized care to monitor a patient, but this is cost prohibitive.

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