Reducing Falls Using Sensing Technology

Nurse researchers at Barnes-Jewish Hospital are pioneering the application of new technologies to reduce the incidence of inpatient hospital falls. Nationally, between 700,000 and 1 million patients fall in U.S. hospitals each year.*

A Barnes-Jewish pilot program conducted on a nursing division has resulted in a 58 percent reduction in the fall rate, and a 42 percent reduction in falls with injury during the trial’s initial phase.

To conduct the pilot study, researchers installed 52 depth-sensing cameras (originally, these were xBox Kinect® cameras) in two general medicine divisions. The cameras collect video of a room’s occupants prior to and during a fall without revealing their identity. The study is providing valuable information to the researchers about the nature of falls and nurse responses.

Sensing Technology Screen CaptureThe cameras record only silhouette forms of those in a patient room, so their privacy is protected. Patients also are advised about the presence of the camera upon admission and given the option of having the system switched off.

To obtain additional data about patient movement, bed sensor mats were installed on one of the two units. By observing a patient’s gait (walking movement), the depth sensor, working with the bed sensor system, is able to compute a patient’s fall risk.

“We’re very excited by our early results,” says Pat Potter, PhD, RN, FAAN, Barnes-Jewish Hospital director of research for patient care services, who is leading the team evaluating the fall prevention technology. “There’s plenty of data on why patients fall, but this study is providing our clinical teams with real-time input and yielding some new insights on why falls happen.”

This is how the system works. As a patient moves around his or her room, the bed sensor and camera gather information that the system uses to automatically compute a patient’s fall probability as high, moderate or low. If a patient is rated as a high fall probability, the next time they get out of bed, an alert is sent to the cell phone of nurses on that unit. In that way, nurses can react before a potential fall occurs. An alert also is sent if a patient of any risk level falls.

Following a fall, information from the system allows members of the project team and unit staff to analyze what patient behaviors or conditions in the room might have contributed to a fall.

“Among other interesting findings, we’ve determined that patients move about in their beds an average of four minutes before getting up,” says Potter. “That’s a window of time that we might be able to utilize in developing an ‘early warning system.’ ”

The project team also has observed patients getting up and falling after a caregiver takes their vital signs in the middle of the night. The project team theorizes that patients, like most every adult, realize they need to use the bathroom before they can go back to sleep. Instead of asking for assistance, they get themselves out of bed and fall. In fact, no patient who fell during the study utilized their call button for assistance with getting out of bed.

In addition to yielding useful, real-time data, Potter believes the study has raised awareness and created an “enhanced culture” around falls in the units participating in the study.

The project team also is comparing the system’s assessment of fall risk to scores obtained from the Johns Hopkins Falls Assessment Tool, which Barnes-Jewish and many other hospitals have used for years to assess a patient’s fall risk.

During the trial phase, 52 sensors were in operation, but the ongoing study has been scaled back to 26 patient rooms.

“We believe we’re the first hospital to implement this technology on this scale,” says Potter.

In addition to this new technology, Barnes-Jewish Hospital utilizes an array of methods to reduce patient falls and to reduce the likelihood of injury from falls, such as:

  • Conducting fall assessments on every patient upon admission and throughout their stay and assigning a fall risk status
  • Discussing with every patient their related fall risk and the importance of asking for assistance if they are identified as at risk to fall
  • Attaching a bright yellow armband to high-risk patients
  • Utilizing a signage system that reminds patients and their visitors about their fall risk status
  • Utilizing bed alarms to notify staff when a high-risk patient is getting out of bed
  • The use of lowered beds and fall mats to reduce injuries from falls

Barnes-Jewish has achieved a 20 percent reduction in falls and a 29 percent reduction in falls with injury hospital-wide since 2009.

* The Agency for Healthcare Research and Quality: Preventing Falls in Hospitals
A Toolkit for Improving Quality of Care

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Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in addition to nurses, technicians and other health-care professionals.

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