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  • Kristin McNealus, DPT, MBA

Step Up So Patients Get Up

Falls are bad, right? I think we can all agree on that. I don’t think any hospital administration ever looked at falls occurring in their facility as insignificant events. Falls within hospital are not uncommon, with statistics ranging from 2.3 to 7 falls per 1,000 patient-days. Approximately 30% of inpatient falls result in injury, with 4% to 6% resulting in serious injury. These falls increase hospital costs related to that patient’s care anywhere from $4000 to $14,000 depending on the severity of the injury. One study even cited an increased cost of $40,000 due to a fall that resulted in a hip fracture. This could certainly open a lengthy discussion regarding the inconsistent health care pricing for any given medical procedure or test, but I digress.

Then another financial power entered the scene. Medicare would not cover any costs associated with the care required due to a fall, lowering reimbursement for that individual’s hospital stay. Fines also have been handed down from federal and state agencies for preventable falls that resulted in serious injury. This is supposed to serve as an incentive to decrease the incidence of falls. However, since hospital revenue is impacted, clearly so is staffing. Nursing ratios have increased over the years, and while having to care for more patients, their workload feels like it has increased exponentially. Documentation is lengthier. Retrieving and administering medications has more steps, and therefore takes more time. And the number of nursing aides has also decreased… Can you see where this is heading?

It is unclear if the incidence of falls has changed with all of the new measures implemented for inpatients. These are not statistics that hospitals want to advertise. However, there are studies regarding the falls that have occurred. We know that the greatest number of falls occur at night; most often in the patient’s room; and 50% are elimination-related. Another interesting statistic found by Hitcho et al. was that while 29% of the patients who sustained a fall, used an assistive device at home prior to hospitalization, while only 6% of the people who fell were using an assistive device at the time of the fall.

That is just a glimpse into how physical therapy can help address the hospital’s bottom line, and we need to let them know.

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