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Prevention of Patient Falls through Perceived Control and other Techniques

Published online by Cambridge University Press:  28 April 2021

Aviva Halpert  and
James P. Connors
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Extract

Every year thousands of patients suffer injury while attempting to make use of bathroom facilities. In addition to the suffering and protracted inpatient care that these incidents cause, hospitals have been faced with staggering costs in the form of increased insurance premiums arising directly out of an increased number of lawsuits. This problem has reached a proportion such that it clearly deserves careful and indepth industry study.

This article, while far from a comprehensive study, will attempt to draw certain conclusions and perhaps dispel certain myths based upon a study of 181 patient falls at a 200+-bed community hospital in the Northeastern United States.

In the not too distant past, hospitals could not generally be held legally responsible for failure to raise bedrails absent specific medical direction. Such was the case because few, if any, hospitals had guidelines or procedures for the placement of bedrails in the absence of a physician's order.

Type
Article
Information
Law, Medicine and Healthcare , Volume 14 , Issue 1 , February 1986 , pp. 20 - 24
Copyright
Copyright © American Society of Law, Medicine and Ethics 1986

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References

According to National Association of Insurance Commissioners, Medical Malpractice Closed Claims, July 1, 1975 - June 30, 1978, 10 percent of all claims paid for medical malpractice during the period reviewed related to falls; 87 percent of these occurred in hospitals.Google Scholar
While some studies have shed light on the issue, a problem of this dimension deserves more industry focus. One major contribution is Rubenstein, H.S., et al., Standards of Medical Care Based on Consensus Rather Than Evidence: The Case of Routine Bedrail Use for the Elderly, Law, Medicine & Health Care 11(6): 271 (December 1983). See also Rainville, N., Effect of an Implemented Fall Prevention Program on the Frequency of Patient Falls, Quality Review Bulletin 9: 287 (September 1984) (while the implementation of high-risk group classification reduced incidents within groups, it is clear that the classification system itself was neither adequate nor sufficiently broad).Google Scholar
Grace v. Manhattan Eye, Ear and Throat Hospital, 301 N.Y. 660, 93 N.E.2d 926 (1950);Mossman v. Albany Medical Center Hospital, 34 App.Div.2d 263, 311 N.Y.S.2d 131 (1970).Google Scholar
Haber v. Cross County Hospital, 37 N.Y.2d 888, 378 N.Y.S.2d 369 (1975).Google Scholar
See Greenlaw, J., Failure to Use Siderails: When Is It Negligence? Law, Medicine & Health Care 10(3): 125 (June 1982).Google Scholar
Bleiler v. Bodnar, 65 N.Y.2d 65, 69, 489 N.Y.S.2d 885, 889 (1985), citing Louisell, Williams, , Medical Malpractice, 1: § 16A-2.Google Scholar
Rubenstein, et al., supra note 2, at 271.Google Scholar
See Man, M., Helplessness: On Depression, Development and Death (San Francisco, 1975), at 123–33.Google Scholar
While it would be interesting to do a cost analysis weighing the expense of patient falls against that of preventive measures, regional variations in DRG (diagnosis-related group) weights and salaries for aides make such a calculation impractical. One could do such an analysis for a specific hospital by calculating the regional DRG rate for the specific fracture or injury under analysis to determine the nonreimbursed expense (under the prospective payment system, reimbursement is provided only for the principal diagnosis, the one that caused the original admission). One would then multiply that expense times the incidence of injury and compare the result with an average aide's salary plus 15 percent for benefits times 1.5 (to allow for weekends, vacation, and sick pay).Google Scholar
The Chicago Hospital Risk Pooling Program seeks to educate patients to the risk of falls by distributing to them a card listing the most common causes of falls in the hospital and giving five guidelines on avoiding such falls. A recent study of the hospital fall problem and suggested solutions can be found in Aggressive Programs Lessen Frequency, Severity of Falls, Hospital Risk Management 7(7) (July 1985).Google Scholar
Non-skid slippers currently cost about four times as much as their paper counterparts (approximately 48 cents for non-skid, as opposed to 12 cents for paper). The longer a patient stays, the smaller this gap becomes, since the paper slippers must be replaced periodically while the non-skid slipper is durable enough to survive most extended patient stays.Google Scholar
See also Greenlaw, supra note 5, at 126.Google Scholar