When people fall in an emergency room, any medical treatment as a result of the fall is paid for by the hospital. Historically, there’s been no assessment tool to ascertain the risk level of falling in emergency departments — until Dr. Kathleen Flarity created one for Memorial Hospital.
“There was nothing in the United States and nothing worldwide,” said Flarity, 51, who has a doctorate of nursing practice. She practices and teaches at Memorial Hospital, and is a colonel in the U.S. Air Force Reserves.
“If a patient falls in our hospital, it’s our fault,” she said. “It’s a measurement of quality for most hospitals.”
Hospital falls account for almost 40 percent of inpatient incidents, most resulting in minor injuries. However, 6 percent of falls cause serious injuries. National studies conducted regarding falls in hospitals have not separated the emergency department from the balance of the hospital.
“We knew the emergency department was different. Our goal is to improve patient safety and reduce falls — but there weren’t any tools looked at in the emergency department. We are the busiest emergency department in the state,” Flarity said.
Between Memorial Central and its North campus, combined, ED hospital staff treat more than 140,000 patients a year, or 400 patients each day.
One study in 2009 compiled information after the fact, so Flarity considered it unreliable. As a result, she “started from scratch” to identify the fall risk in all the patients admitted through the emergency department at the Memorial’s hospitals, Central and North.
Nurses in the emergency department collected data on each patient. For each patient, they mapped the fall risk criteria.
Research showed the population is younger in the emergency room than those admitted to the hospital, Flarity said.
“Every single patient who came in to the emergency room, the admitting nurse would assess the fall risk,” she said.
Before the study, not all falls were counted. The study, conducted from 2010 to 2012, considered 91,190 emergency department patients — only adults, and of those, 110 patients fell. Of those falls, there were no significant injuries, she said.
“Our Central campus has a higher acuity, and we have the behavioral health unit,” Flarity said.
“Now there’s something that every single emergency department in the world can compare theirs against,” she said of the fall rate. The study found that 44 percent of the people who fell were intoxicated. The mean age was 46.
“Originally, I thought it was the older people who fell,” Flarity said.
Following the study, the hospital instituted a program for persons at risk for falls. The system requires patients at high fall risk to wear yellow booties and a yellow gown. Depending on the criteria, patients at a higher risk would be required to have an alarm on the bed.
“If a patient started scooting off the bed, the alarm would go off,” she said, highlighting the geriatric population. “If a patient wets or soils themselves, based on the literature, they’re more likely to fall because they try to get out of bed.”
Part of the process includes education, as health care professionals clarify to patients and their family members why the patient is wearing yellow.
Now that every patient is assessed for fall risk and all falls are being reported, “we’re seeing 16.7 percent fewer falls, and 100 percent reduction in serious injuries,” Flarity said.
Flarity copyrighted her study, so others who want to study falls in their hospital emergency departments using her risk-assessment tool must request permission from her.
So far, nine emergency departments from Arizona to New Jersey are using the tool to study falls. Flarity said there was a void, so she filled it.
“When you look at the data and see there’s nothing out there,” she said, “you just kind of have to do something.”
In August, the hospital had its lowest fall rate, with 1.19 falls per 1,000 patients, said Paula Freund, media relations specialist at Memorial.
“We had seven falls in the month of August, and that’s the lowest ever since we started measuring falls,” she said. “That’s all the effort of everyone being vigilant.”