Hospitals 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.
This content is sponsored by CareView Communications
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 hospital systems. CMS does not pay for care rendered as a result of failure to keep patients safe, and the cost of falls to hospitals increases 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 reimbursements, means hospitals face a serious payment deficit. It follows that an increase in liability and length of stay is imminent 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 independence, 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-dependent 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 solutions. 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.
Virtual sitters are categorized by the use of video monitoring, which require a large, upfront capital expense. These systems can include the capability of communication with the patient in the form of one-way remote dialogue to the room to cue patients to stay in bed, and some systems allow the patient to respond in a two-way exchange. Because it relies solely on human diligence in monitoring, virtual sitters do not necessarily reduce the cost of salaried sitters — the greater number of monitored patients still requires greater personnel to safely monitor the program.
Generally, video monitoring depends on the quality of the camera, and the portability of the device leads to more opportunity for breakage. Many times, camera devices are dependent on wireless functionality and heavy bandwidth usage, potentially slowing other operations in the healthcare setting.
Enhanced video monitoring may also be "conveniently" portable, but is also vulnerable to breakage and loss. If plugs and cables are required, this form of monitoring can actually present a greater fall risk to patients and visitors. These cameras share other negative attributes with video monitoring: they do not allow more time to respond, are dependent on the quality of the camera and wireless internet functionality, and interrupt operations of other applications by consuming large amounts of bandwidth. Once again, the process for rescuing the patient is reactionary.
Healthcare workers are constantly responding to weight relief, alarm noises, or actual falls. Summarizing the available technologies to date, it is known from the literature that reactive processes do not reduce fall rates, the costs associated with falls or the prevention of harm from falls.
Beyond video monitoring: The CareView approach
More hospitals are seeing value in investing in fall prevention solutions. Until recently, the only alternatives besides costly, personal sitters or ineffective alarms were expensive video-monitoring systems.
CareView Communications offers the opportunity to protect patients from harm, protect reimbursement and implement proactive solutions for at-risk patients. In addition, the results are more consistent because CareView's solution utilizes predictive monitoring technology rather than human surveillance to alert staff.
Other benefits of the CareView® solution include its predictive capabilities and ability to integrate with the EHR, data capture for analysis and use of television cable that is less prone to outage. The technology is flexible and efficient, and its predictive nature allows additional time to react and prevent falls. The single most differentiating feature is the application of Virtual Bed Rails® and Virtual Chair Rails® Technology.
Virtual Bed Rails and Virtual Chair Rails are based on motion-detection software that provides advance notice of a patient's intent to rise. The infrared cameras and specialized room control platforms combine to provide HIPAA-compliant, secure observation as needed. The early notification provides more time to respond, increasing the likelihood of successful fall prevention. The patented algorithms within the software create invisible borders around beds or chairs, and when the preset limits defined by the trained caregiver are breached, the caregiver is alerted immediately. This innovative, early notification system has resulted in 40 percent to 75 percent reduction in falls.
Another distinguishing benefit of the Virtual Bed Rails and Virtual Chair Rails technology from CareView is the use of captured data. The software integrates with the EHR to provide valuable insights. With this platform, an analyst has the ability to separate patients by type, such as ventilator dependent patients, core measures diagnoses, risk for violations of National Patient Safety Goals, and others. It can provide readily available, accurate quality data to easily measure nursing sensitive outcomes. This objective data is valuable after an event, such as when the Virtual Bed Rails or Virtual Chair Rails are activated. More importantly, it provides data prospectively to identify fall risk and aid in implementation of an effective care plan that supports fall prevention.
Summary
The link between hospitals' financial and clinical priorities has never been so apparent. There are high penalties for failure to prevent harm and recover patients who experience adverse events in hospitals. One fall with injury can increase length of stay, place the patient at risk for additional complications, and cost the system tens of thousands of dollars per event. That cost is well above what CMS would have paid for the original diagnosis that initially brought the patient to the hospital.
The complications of patient falls are virtually endless. CareView Communications has the solution: Virtual Bed Rails and Virtual Chair Rails are the predictive technologies that will make a difference in the culture of patient safety.