Yale-New Haven Hospital Reducing Fall Rates through Rapid Cycle Tests of Change

Purpose:
To develop sustainable strategies for reducing the incidence of falls at YNHH by 50% by October of 2009 through the rapid cycle change process (plan-do-study-act PDSA cycles). To hardwire the "Stay with me" intervention on inpatient adult units.

Significance:
50% of falls in the hospital are related to toileting. In 2000, direct medical costs totaled $179 million for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al., 2006). In October 2008, Medicare stopped reimbursing hospitals for costs associated with inpatient falls.

Strategy and Implementation:
We chartered a multidisciplinary rapid cycle PDSA Team to address falls incidence at YNHH starting on on general medicine unit. The Team chose to implement the "Stay with me" intervention: staff members stay within arms reach of designated patients during toileting. Staff from additional units will be incorporated into PDSA teams as the fall safety practice changes spread throughout the organization and only after previous units have had full education and demonstrate success. Celebrations are regularly scheduled. Deliberate implementation strategies include: 1) Use of best practice through a literature review and participation in the Connecticut Hospital Association Fall Safety Collaborative. 2) Use of data to assess progress and to target interventions. 3) Staff education on hourly rounding and on the rational for the “Stay with me” intervention. 4) Roll out of new fall safety equipment including chair alarms, walkers and canes. 5) PDSA cycles of change.

Evaluation:
The project launched the week of February 17, 2009 on the pilot unit. The project is still underway but the Fall rate related to toileting has trended downward from 9 in January to 0 in May. Roll out of the "Stay with me" intervention to other inpatient units will launch shortly.

Implications for Practice:
Challenges include determining the clinical parameters for patients who should receive the “Stay with me” intervention, hardwiring effective practice changes, staff intra-shift communication, and replicating the PDSA process on other units to reduce the hospital wide fall rate.