JMIR Publications

ABSTRACT

Background:

Patient falls are the most common adverse events reported in hospitals. 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 Veteran Administration medical centers. Thus, the overarching goal of this study is to identify unit design factors contributing to inpatient falls within the Veterans Health Administration.

Objective:

Aim 1: Investigate front-line and management perceptions of and experiences with Veteran falls as they pertain to inpatient environmental factors. An iterative Rapid Assessment Process will be used to analyze the data. 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. Aim 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:

Aim 1. We will conduct walk-through interviews in 12 medical/surgical units at three Veterans’ Administration medical centers in Florida unit and facility personnel to identify environment-related fall risk factors at each site. Data will be used to finalize an Environmental Assessment Survey for nurse managers and facilities management leaders. Aim 2. We will use fall data from the VA Inpatient Evaluation Center and patient data from additional data sources to identify med/surg 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 by analyzing computer aided design files of unit floorplans, and environmental factors, based on the Environmental Assessment Survey. Statistical tests will be performed to identify those design factors that distinguish high and low outliers.

Results:

Data collection and analysis was completed for Aim 1 with a manuscript of results in progress. For Aim 2, the medical/surgical units were categorized into higher and lower than expected falls categories, the Environmental Assessment Surveys were distributed, and data to measure spatial characteristics are being compiled.

Conclusions:

To our knowledge this study is the first to objectively identify spatial risks for falls in hospitals within in a large multi-hospital system. The proposed research design employs multiple methods to paint a complete picture of fall risk in medical/surgical units, leverages the large VA administrative databases to identify nursing units that have the highest and lowest risk-adjusted fall rates, and creatively combines spatial analyses to identify fall risk.