How Do ED's Compare When Trying to Catch a Falling Star!

Purpose:
The National Patient Safety Goal 09.02.01 asked organizations to implement a fall reduction program and evaluate the program. This Emergency Department (ED) wanted to see how its number of falls compared to other emergency departments and implement a fall reduction program.

Significance:
It was important to establish a quality indicator for falls in the ED and begin the process of setting a goal and threshold. Inpatient nursing collected and reported data based on falls per 1000 patient days. How should ED's compare falls rates? Falls per 10,000 ED visits was selected.

Strategy and Implementation:
A quality indicator needed to be established. Initial fall data was collected in 2008.There were falls that occurred during this time. The question of setting a goal and threshold was raised. How did this compare to other emergency departments? A literature search was done which revealed that very little comparison data was available. The Emergency Nurse Association 2005 National Emergency Department Benchmark Guide did not have benchmark data for comparison. The ENA Educators list serve was polled to see if this information could be shared. The average falls per 10,000 visits in this limited sample was 2.82 falls per 10,000 visits. This hospital's ED fall rate was 5.1 per 10,000 visits in 2008. This hospital ED began by including a fall risk assessment on every patient who presented to the ED and when indicated, initiate interventions.

Evaluation:
Fall data was collected monthly and reviewed at the ED quality assurance committee meeting. A target of 4 was set. With interventions in place, fall data in 2009 our hospital's falls per 10,000 visits reflected 2.3. Our fall rate increased to 4 in 2010, but is currently 1.1 for the past 6 months.

Implications for Practice:
With annual census changing, it is important to have a valid means of evaluation. As emergency departments, it is also important to benchmark with other ED's. ED's need to be more transparent so best practices can be shared.