INCREASING MOBILITY AND REDUCING FALLS AND FALL-RELATED INJURIES IN HOSPITALIZED MEDICINE PATIENTS

Jessica Caro, MD;Shirley L Jiang, MD MPH*;Jessica Mathis, PT DPT;Suzanne Cushnie, BSN MSN;Sigal Israilov, BA;Yu Sakai, BA;Jasmine Race, BA;Aishwarya Raja, BS and Hyung Cho, MD, Icahn School of Medicine at Mount Sinai, New York, NY

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 173

Categories: Innovations Abstracts, Quality Improvement

Keywords:

Background: Hospitalized patients have significantly reduced ambulation, which leads to decreased muscle strength, coordination, and balance, all which increase the risk of falls. According to the Joint Commission, hundreds of thousands of patients fall in hospitals every year, resulting in injury in 30% to 50% of cases. Serious injuries, such as fractures, subdural hematomas, excessive bleeding, and death, are sustained in 4% to 6% of falls. Fall-related injuries cost the hospital an average of $14,000 per incident and prolong length of stay by an additional 6.3 days. The American Academy of Nursing has chosen ambulating elderly patients as part of their Choosing Wisely campaign to improve quality of care. Ambulation increases hospitalized patients’ ability to independently perform activities of daily living and is associated with a reduction in falls and fall-related injury, length of stay, and discharges to skilled nursing facilities.

Purpose: Our goal is to reduce falls and falls-related injury through a multifaceted approach focusing on mobility and safety.

Description: A multipronged quality improvement initiative was implemented at Mount Sinai Hospital on a 34-bed medicine unit. The interventions included (1) a “mobility hour” dedicated to staff-assisted patient ambulation; (2) an education and awareness campaign for medical providers on safe ambulation and fall precautions; and for select high-risk patients: (3) remote camera patient monitoring, (4) bedside falls mats to prevent injury, and (5) patient Fitbit use to help quantify their daily steps.

Baseline data was measured from 1/1/15 – 12/31/15 (12 months), and intervention data was measured from 1/1/16 – 10/31/16 (10 months), when the last preliminary data was collected prior to submission. Falls and falls with injury were measured per month utilizing our medical error recording system.

The next steps will involve implementing interventions to motivate patients to ambulate, including (1) establishment of a medical student interest group that will organize students to walk with patients, (2) environmental changes on the unit to make it more friendly for patient ambulation, and (3) providing Fitbits to the medical assistants and having friendly competitions among them to see who walks the most with patients.

Conclusions: Our robust multimodal falls initiative led to a decrease in both falls and falls with injury, which in turn amounted to notable cost savings. Falls decreased from an average number of 4.3/month to 3.6/month, and falls with injury decreased from an average number of 0.5/month to 0/month (see Table 1). Estimated cost savings per year was $84,000, based on estimates in literature for inpatient falls with injury.

Through our unique multidisciplinary initiative, we hope to continue these gains to further improve the quality of care we provide to our hospitalized patients.

To cite this abstract:

Caro, J; Jiang, SL; Mathis, J; Cushnie, S; Israilov, S; Sakai, Y; Race, J; Raja, A; Cho, H . INCREASING MOBILITY AND REDUCING FALLS AND FALL-RELATED INJURIES IN HOSPITALIZED MEDICINE PATIENTS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 173. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/increasing-mobility-and-reducing-falls-and-fall-related-injuries-in-hospitalized-medicine-patients/. Accessed July 23, 2019.

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