In this space the last few weeks, we have discussed how the best and safest care that leads to the best outcome for the patient is often the least expensive option as well. Sometimes all it takes is some focused attention on a basic component of patient care to get the best – and least expensive - result.
Let’s take patient falls as an example. Patients fall in every hospital in the United States. Many of these patients are elderly and compromised physically in any number of ways. They are often medicated and trying to negotiate unfamiliar surroundings. These falls can injure a patient, which is the worst outcome, but they also lengthen the patient’s hospital stay, increase anxiety and add cost to their care. Hospitals everywhere strive to prevent patient falls, and Medicare will even penalize those whose rate is too high.
Our fall rate at New Hanover Regional Medical Center three years ago was “acceptable” under national standards. But we knew we could do better. “Acceptable” does not mean the rate was where it could or should be. We knew we should continuously strive to do better.
Through Lean methodology, we assessed our current state and agreed on simple tactics, performed the same way, every time, which we refer to as “standard work.” This is how health care is going to improve for the patient and for the payor.
As part of our Lean effort, we formed a Patient Safety Services Fall Team, which looked into the underlying causes of why patients fall and what can be done to prevent it. Typical causes are medicated or disoriented patients, many of them already with physical impairments, tripping in unfamiliar surroundings or unable to reach the bathroom. Any patient can fall, but many are preventable. Those are the ones we focused on.
The implementation was largely carried out through a team model of nursing which makes maximum use of the license and skill of each team member, a model called “SharedCare” that we are using to transform how patient care is delivered.
Our standard became for the nursing team to check in with the patient every hour in an organized fashion so it could anticipate patient needs, such as going to the bathroom, the source of 54% of patient falls. The team also found that medications can be more strategically administered, so that patients are more likely to sleep through the night and less likely to have to get out of bed to go to the bathroom.
We also developed a way to identify those patients who are high risk of falling. We give them yellow socks to wear, which reminds the patient of the risk and alerts all care providers that the patient is a fall risk. We also place a sign in the patient’s room that identifies the risks and how caregivers should respond.
Nurses also talk with patients and families about their roles in preventing falls. And we make sure a walker is placed in every room.
Clinical units post notices in their meeting area indicating how many days they have gone without a fall. After every 30 days without a fall, they celebrate. When a fall does occur, the nursing staff conducts a “fall huddle” with the team to discuss what happened and how it can be prevented going forward.
These are relatively simple steps that cost very little and require almost no technological investment.
Have they worked?
In the past year, patient falls at NHRMC have decreased 22%, leaving us with a rate of 2.5 per 1,000 patient days. National industry sources calculate that a typical fall costs the healthcare system $8,000 to $13,000. Given those estimates, that reduction in falls saved the system more than $500,000.
The savings were realized by whomever pays the hospital bill. Most of the savings likely went to the government, while some went to insurance companies, some to employers, some went directly to the patient and some back to the hospital. As we transition to an “accountable care” payment system, in which we are paid based on how healthy we keep patients and how well we control costs, the hospital provider and patient will both benefit.
Most important, though, is that all of the improvement in patient care went to the patient.
This is but one example of how healthcare providers, by standardizing best processes and consistently following them, can change the delivery of care, one improvement at a time. Over time, these improvements will add up to better patient experience, better quality of care and significant savings. Health reform centered on patient safety and quality is something we are excited to take part in at New Hanover Regional Medical Center.