Hospitals reduce serious falls 64% by sharing data, strategies

An 18-month patient safety effort by 21 hospitals in the Cincinnati, OH, region has reduced incidents of patient falls that result in injury in these hospitals by 64%, and one of the key reasons is that the hospitals did something that might have made risk managers gasp in recent years: They shared their own proprietary data about falls.

Before this effort began, the hospitals were working individually to reduce the risk of falls in their facilities. But the decision was made that progress could be made more quickly by working together, says Steve Muething, MD, vice president of patient safety at Cincinnati Children’s Hospital Medical Center and chair of the Greater Cincinnati Health Council (GCHC) Harm Reduction Collaborative. Through the GCHC, a hospital membership organization, the 21 hospitals agreed to share incident data with one another for the first time and to use a formal improvement model developed by the Institute for Healthcare Improvement.

The hospitals previously had shared some data for other collaborations, says Dora Anim, MPA, vice president of quality and data at the GCHC who helped lead the organization’s Harm Reduction Collaborative. Still, this effort was different. “This was harm data. It was data around what happens to our patients while they’re in a hospital,” Anim says. “That is different for hospitals from sharing other types of information.”

Muething points out that sharing data normally kept confidential will work only when senior hospital leaders endorse the effort. “When our senior leadership agreed not to compete on safety, agreeing to have a common measure and share our data and best practices, that set the stage for the nurses, the doctors, the risk managers, the quality improvement people to come together and know that it was not only OK to work together, but that senior leaders wanted them to work together,” Muething says.

One important point for the collaboration was an agreement that data would be shared publicly only for the group, never for a single hospital, Anim says.

The hospitals set a goal of reducing by 50% the regional rate of patient falls that occur in hospitals and that result in moderate or severe injuries. They surpassed that goal by achieving a 64% reduction. In fact, an improvement was made in overall falls as well as falls resulting in injury.

Eighteen months ago, approximately 250 patients per month experienced a fall within the 21 participating hospitals in this region, and 11 patients per month had a fall that resulted in serious injury. The GCHC reports these current results:

  • 48 fewer patients are falling per month (or two less patients per day).
  • Seven fewer patients per month are experiencing a fall that results in a moderate or major injury.

“I think the impressive results of this initiative prove that true collaboration among healthcare leaders and clinicians can create meaningful transformation in patient safety and quality of care,” Muething says. “Our goal is to continue to improve until we get to zero falls, but this is tremendous progress in a short amount of time.”

The average hospital stay for patients who fall is 12.3 days longer, and injuries from falls lead to a 61% increase in patient care costs, Anim notes. “Our safety collaborative chose to work on reducing falls that result in injury because of the impact on patients and because they result in higher overall costs,” Anim says.

Small tests of change were a key strategy for this work, Muething and Anim explain. A group of patient safety and clinical hospital representatives from the various hospitals convened each month. They alternated between learning sessions in which teams from the hospitals came together to plan changes and action periods in which the teams returned to their organizations and tested those changes in clinical settings.

Some tests of change were proven effective, and some were not. For example, some hospitals piloted the use of a new toilet seat alarm in an attempt to reduce patient falls without great results. Regardless, hospitals shared findings with the entire group so all could learn. (See the list below for more information on what changes were effective.)

It was important for the collaboration participants to remember that their work had a human impact, rather than focusing exclusively on data, Muething says.

“We wanted to remind people every time we met that there were people behind these numbers and that reducing falls could have a major effect on people’s lives,” Muething says. “When we discussed an incident, we talked about the patients and how the falls affected them and their families after they came into our hospitals to get better. That was important to show the devastating effects a fall can impart on people, aside from the numbers and the costs.”

Sources

  • Dora Anim, MPA, Vice President of Quality and Data, Greater Cincinnati Health Council. Telephone: (513) 878-2857. Email: danim@gchc.org.
  • Steve Muething, MD, Vice President of Patient Safety, Cincinnati Children’s Hospital Medical Center. Telephone: (513) 636 -2068. Email: stephen.muething@cchmc.org.

Strategies that Helped Hospitals Reduce Falls by 64%

  • Hospitals change risk assessment procedures to include more patients or all patients rather than only high-risk patients.
  • Increase the frequency of unit meetings where incidents of falls are evaluated. Some hospitals moved from monthly meetings to weekly.
  • At some hospitals, a trial of different motion detectors, bed alarm systems, and bed positioning that could impact falls.
  • Some hospitals implemented “purposeful rounding” – a proactive intervention in which nurses (or a combination of nurses and other healthcare workers) do bedside rounding on patients at regularly scheduled intervals – usually every hour. Hospitals used the rounding to assess the “4Ps” (pain, position, potty and proximity of personal items) which helps to minimize the instances of patients trying to get out of bed.
  • Some hospitals experimented with post-fall team huddles after an incident to immediately assess the issues that led to a fall and put a solution in place to prevent further incidents.

Source: Greater Cincinnati Health Council (GCHC).