Falling is the most common type of accident reported in U.S. hospitals today. The rate of falls ranges from 2.3 to 7 falls per 1,000 patient days; up to 33% of reported hospital inpatient falls result in injury, with 4 to 6% resulting in injuries serious enough to lead to impaired rehabilitation and co-morbidity or even death. Falls are associated with increases in the length of hospital stays and higher healthcare costs. They can also result in higher rates of patient discharges to long-term institutional care and litigation against hospitals. Research shows that hospitals can reduce the incidence and severity of falls by identifying risk factors and introducing appropriate interventions.

PI: Craig Zimring

The Portfolio and Planning Management Division, Office of the Assistant Secretary of Defense, Health Affairs is funding a baseline study exploring links between design and outcomes in the existing four National Capital Region (NCR) military treatment facilities (Walter Reed Army Medical Center, National Naval Medical Center - Bethesda, Malcolm Grow Medical Center at Andrews AFB and Fort Belvoir’s DeWitt Army Community Hospital) and up to three non-military hospitals, including Dublin Methodist Hospital in Ohio.

This is a joint effort including: teams from each facility, the Department of Defense (DoD) Patient Safety Analysis Center, the US Army Public Health Command (provisional) Ergonomics Group, Noblis and Georgia Tech. Craig Zimring is overall Principal Investigator (PI), Julie Mann-Dooks is co-PI and Noblis lead, and Erin Lawler is the DoD Patient Safety Analysis Center (PSAC) lead. Each DoD facility has a local PI. A larger team of clinicians, methodologists and researchers are making substantial contributions.

Healthcare Environments Baseline Assessment for Safety & Quality. Falls: Patient falls are a leading harm event reported to the Department of Defense Patient Safety Analysis Center. This study will support research-based decisions about design, processes and procedures to reduce falls.

The falls study has both retrospective and prospective components. The retrospective study explores the contribution of physical design to falls, over and above demographics and other intrinsic factors and technologies such as fall prevention programs. The team will study all falls from 2007-2009 using a case-control method, and will analyze the design of the physical environment of fallers and non-fallers. For the prospective study, a new falls reporting form will be piloted on which nurses can indicate exact locations of and temporary conditions that contribute to falls. Nurses and nurse managers will describe their current fall prevention activities and how they react to falls, and the team will shadow nurses and conduct behavior mapping in order to understand how nurses respond to high-fall-risk patients. The methodology for this study was developed by task leads YoungSeon Choi of Georgia Tech and Erin Lawler of the PSAC, with assistance from the rest of the team.

KEY OUTCOMES ENVIRONMENTS BASELINE FOR SAFETY & QUALITY (HE-BASQ)

Noise: Hospital noise levels have been increasing nationally over the past 20 years, and noise contributes to stress (for patients, families and staff), errors, lowered satisfaction, and other outcomes. The noise study assesses whether the new NCR facilities reduce noise levels, and findings will inform future design decisions to reduce noise and negative conditions associated with noise.

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