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IIR 16-063 – HSR&D Study

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IIR 16-063
Nursing Unit Design and Hospital Falls
Ronald I. Shorr MD MS BA
North Florida/South Georgia Veterans Health System, Gainesville, FL
Gainesville, FL
Funding Period: March 2018 - February 2021

BACKGROUND/RATIONALE:
Each year, roughly one million patient falls occur in United States hospitals resulting in over 250,000 injuries and 11,000 deaths. Patient falls cost hospitals due to increased lengths of stay, health care expenditures, and litigation. As of March 2015, the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS) Patient Safety Information System, a confidential and non-punitive reporting system, showed that falls were the most frequently reported category of patient harm across the Veterans Health Administration (VHA). Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or fatal hospital falls, there are significant gaps in our knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital or a small number of inpatient units, limiting generalizability. Furthermore, there have been no studies focused on unit design and falls in VA medical centers (VAMCs).

OBJECTIVE(S):
The overarching goal of this study is to identify unit design factors contributing to inpatient falls within the VHA. The specific aims of this study are to: 1) investigate front-line and management perceptions of and experiences with Veteran falls as they pertain to inpatient environmental factors; and 2) quantify associations between unit design factors and fall rates by comparing spatial and environmental factors of units with higher- versus lower- than expected fall rates.

METHODS:
For Aim 1, we will conduct walk-through interviews in 12 medical/surgical units at the Malcom Randall VAMC in Gainesville, the Lake City VAMC in Lake City, and the James A. Haley Veterans' Hospital in Tampa with unit and facility personnel to identify environment-related fall risk factors at each site. Interview findings will directly inform the development of an Environmental Assessment Survey to be conducted as part of Aim 2, as well as, contribute to interpretation of Aim 2 results.

For Aim 2, we will use fall data from the VA Inpatient Evaluation Center (IPEC) and patient data from additional data sources to identify medical/surgical nursing units with higher- than expected (n = 25), and lower- than expected (n = 25), fall rates. Once these units are identified, we will measure spatial factors, analyzing computer aided design (AutoCAD) files of unit floorplans, and environmental factors, based on the Environmental Assessment Survey developed in Aim 1. Statistical tests will then be performed to identify those design factors that distinguish high and low outliers.

FINDINGS/RESULTS:
No findings/results to report at this time.

IMPACT:
The reduction of patient falls is a major goal of the VHA. This study represents the first time that the components of unit design will be examined as contributors to fall rates across the hospitals. Synthesis of the rich information provided by the walk-through interviews of frontline staff, the spatial analyses, and the environmental inventories will provide evidence upon which to build improved hospital fall prevention programs and improved hospital design as the VA continues to expand, renovate, and improve its overall infrastructure.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: Prevention
Keywords: Patient Safety, Systems Engineering
MeSH Terms: none