Health Care's 'Thorny Problem' That Just Won't Go Away

Patient falls are a pesky problem. Nearly 1 million patient falls occur in hospitals each year, according to the Agency for Healthcare Research and Quality. One fall can lead to myriad consequences that no longer are acceptable in a value-based health care world, with each spelling an extra 6.3 hospital days and $14,000 in costs, the Joint Commission estimates.

So it should come as no surprise that patient safety experts are advancing sensible solutions, as well as advocating that hospital leaders pay more attention to the problem.

As part of today's White House Conference on Aging, the Centers for Disease Control and Prevention further promoted STEADI — Stopping Elderly Accidents, Deaths & Injuries. The program offers a host of toolkits to providers for preventing falls and patient harm. Today's White House meeting comes on the heels of a meeting in April that focused exclusively on patient falls.

It's also a topic that we've been monitoring for a while. In last month's issue of Hospitals & Health Networks, we took a closer look at how one Mississippi academic medical center was able to drastically reduce its number of falls. The story comes complete with not one, but two BuzzFeedlike numbered lists that everyone on the Internet seems to love on how to wrap your brain around patient falls.

We wrote the piece partly because this cover story that we put out two years ago on falls still keeps showing up on our list of most popular articles (some sort of magic Google pixie dust, I assume). Evidence of the topic's popularity seems to show up every other day in my work, like at the National Patient Safety Foundation Congress earlier this year. Every other poster in the exhibit hall was about one hospital's pilot project to quash patient falls, and one keynote speaker complained that, if he had to read one more study submitted to his academic journal on falls, his head would spin.

"There are a ton of different interventions and yet, despite of all of this, we still have falls,” Tejal Gandhi, president and CEO of the NPSF, told me in an interview. "It's been a thorny problem because, even with all of the tools at our disposal, falls still happen, perhaps at less frequency than in the past, but they are still happening.”

A number of other tidbits have come across my desktop on falls in the past month or so. Harvard Medical School experts note that there are six low- or no-cost modifications (another list!) that can be made to patients' homes to help avoid falls. Those changes — which include such no-brainer stuff as handrails and improved lighting — led to 26 percent fewer injuries from falls, one 2014 study determined.

Another recent study found that using a comprehensive prevention program, developed by Health & Human Services, resulted in big reductions in falls and the subsequent use of health care services. Using an in-home assessment of patients' health, physical functioning, falls history, home environment and medications, researchers created individualized recommendations for senior long-term care patients. That helped to spell a 13 percent lower rate of falls, and 33 percent reduction in long-term care insurance claims.

Yet another recent study, published last month in the Journal of the American Medical Informatics Association, found that incorporating electronic health record data into predictive analytics algorithms could help hospitals to better predict a patient's risk of falling.

Whatever solution your hospital chooses to prevent falls, it's critical that leadership support those efforts, Erin DuPree, M.D., chief medical officer and vice president of the Joint Commission Center for Transforming Healthcare, told me for the story last month.

"It does take a leadership commitment,” she said. "Leaders must give the people who work on falls the time and the resources, and actually lift barriers for those working on this difficult problem. The most important thing leaders can do is (a) recognize the problem and then (b) make sure teams they have working on it are given the tools they need.”