Beyond Video Monitoring: Predictive Technology for Fall Prevention

Transcription

1 Beyond Video Monitoring: Predictive Technology for Fall Prevention

2 Overview of The Problem: Increasing pressure is being placed on hospitals to improve quality, increase patient satisfaction, and protect ALARMING STATISTICS patients from adverse events. Reducing patient falls has been identified as a critical area to achieve these goals; however, there has been a failure to identify defined, sustainable practice solutions to decrease fall rates through the utilization of alert bracelets, bed alarms, side rails, and restraints. 3,17 Falls are among the leading causes of increased morbidity and mortality in hospitals and healthcare systems, with at least 30% of these occurrences resulting in injury to the patient. 2 A fall in a hospital averages an increase in cost of nearly $14,000 per patient stay, 3 which is grossly understated because the cost of a fall has more impact than immediate monetary cost to a hospital. In addition, it is estimated that at 2013 expenditure from patient falls was $34billion 1 Hospital cost per fall average is $14, % of falls in elderly result in major injury 1 out of 3 people over the age 65 fall annually 15 2% of discharged experience a fall 1 Among Adult Inpatients, Falls Is the most reported adverse event and the leading cause for hospital acquired injury 14 least 3-20% of those that actually cause harm to the patient. 4 The 2013 expenditure resulting from patient falls topped $34 billion. 1 The economic hit from legal proceedings alone has encouraged rational healthcare leaders to seek and demand a solution to the problem of patient falls. Penalties for failure to rescue and to prevent harm have been assessed to hospitals that do not provide the necessary, critical surveillance these patients require. While the impact of falls on the healthcare system is divided into monetary and non-monetary effects, all negative outcomes have the potential to increase the cost of healthcare through increased risks.

3 The seemingly non-monetary costs associated with patient falls, such as decrease in the level of trust the patient and/or his family has in the care provided, does translate to a financial risk due to loss of business. Overburden on the local healthcare system, which can be defined by worked hours in response to a fall or overstaffing in anticipation of a fall, is another taxing issue experienced by hospitals caring for at-risk patients. Increased length of stay places the patient at risk for more hospital-acquired conditions. The physical labor involved in recovering patients after a fall induces injury to the healthcare worker and stresses the workforce. Staff involved in a patient fall experience guilt, frustration, and decreased job satisfaction. Falls have always been a significant problem, but since the appropriate push for improved care and prevention of injury, there has been more meaningful attention from a regulatory standpoint. Some states have legislated safe patient handling laws and mandated requirements for justification of safe patient handling procedures, equipment, and reporting. 5 A health system s ability to prevent injury to patients is publicly reported, and violations of associated patient rights are A HEALTH SYSTEMS ABILITY TO PREVENT INJURY TO PATIENTS IS PUBLICLY REPORTED prime standards targeted by surveyors. Other indirect costs associated with patient falls are disability, loss of independence, psychological effects of increased anxiety related to embarrassment and possibility of repeat falls, lost time from work or household duties, and decreased quality of life. 1 Patients at risk for falls are identified through a number of scoring techniques; the efficacy of which may be questionable since no real decrease in numbers of falls or associated costs has been realized over

4 time due to over complex, over sensitive, and unproven scoring tools. 7 In addition to the initiative for patient satisfaction, the Institute for Healthcare Improvement has launched the Triple Aim Initiative imploring the health system to optimize performance to further improve the patient s experience of care, improve the health of populations, and reduce per capita costs of care. One of the measures to meet these requirements is to identify populations at risk. Inarguably, the reactive approach to patient falls is insufficient and more proactive measures are warranted. Patient falls are incongruent with the Triple Aim measures of quality, patient satisfaction, prevention of injury and health promotion, cost reduction, integration of coordinated care strategies, and individual and family perspectives of care. Fall risk escalates with age, increased severity of illness, decreased functional capacity, and past history of a fall. Additionally, delirium occurs in fifty percent of older patients, and is associated with higher fall rates, undesirable clinical outcomes, and higher costs of hospitalization. 9 Nearly 25,000 U.S. elders died from injuries related to falls in It is reported that one out of three people over the age of 65 fall each year, and alarmingly less than half report the fall to a healthcare provider. 1 This underreporting places them at higher risk for falls in the hospital without the opportunity by nursing to identify them appropriately using current tools. Financial Implications Financial repercussions abound for hospitals. They cannot afford unsafe practices, but adding the cost of one on one sitters negatively impacts fiscal performance. CMS does not pay for care rendered as a result of the failure to keep patients safe, and the costs of falls to hospitals increases year over year. CMS began to look as hospitals based on Hospital-Acquired Conditions (which include falls) and adjusting reimbursement for low performing hospitals, compounding

5 the financial implications for hospitals. Hospitals have resorted to providing constant observation as a measure to keep patients safe; however, this did not decrease the length of stay for at-risk patients and resulted in high costs associated with paid human observers. Further, these observers often have limited training and guidelines for their role as a sitter. Hospitals may utilize certified nurse s assistant, but this often Financial Implications pulls that resource away from being available to $14,000 cost of care x 2% of discharges that experience a fall = $500,000 per year for even a small community hospital 1,3 Average Fall cost $8,000 in diagnostic testing Estimated average cost to hospital per patient day $2033 nationally 13 Fall investigations utilize a significant amount of administration time and focus If a fall leads to injury or other hospital acquired condition due to prolonged hospitalization the cost increases to an estimated $85,000 per incident aid in other patient care duties, further taxing patient care efforts. Healthcare Finance gurus estimate a $1.7M cost for falls for a 200 bed hospital per year. 8 Since 2008, the Centers for Medicare and Medicaid Services (CMS) has responded to hospital-acquired conditions by not paying for the services required to recover the patient. 10 Since 2% of the 35.1 million discharges a year experience a fall, 1 this has created a serious payment deficit to hospitals. It follows that an increase in liability and length of stay is imminent after a patient fall. Since no reported decrease in falls has been realized, and the costs associated are increasing, the situation begs for innovation and solutions that work. Fall Prevention Challenges Until now, existing strategies employed to reduce falls and their associated complications and costs have been limited to risk assessment tools, reaction-based alarms, human sitters, virtual sitters, and video monitoring. Desperate for compliance and patient safety, the healthcare industry has responded with various tools to assess a patient s risk for falls; presumably to focus

6 attention on those likely to experience a fall. Among the most widely used falls risk assessment tools are the Morse Fall Scale, Hendrich II, STRATIFY, and the recent Johns Hopkins falls risk assessment tool (for which there is little literature available). Some risk factors are not captured and nearly all patients fall into a high to moderate risk category with these tools. 6,8 With more than forty falls risk assessment tools, there are FALL RISK ASSESSMENT TOOLS ARE FREQUENTLY BEING REVISED - AN INDICATOR OF THEIR INABILITY TO PREDICT RISK no clinically significant reductions in patient harm with many of the risk-based assessment techniques. These tools are frequently being revised- an indicator of their inability to predict risk and provide a false sense of security to healthcare workers. Alarms vary by type, but the most common are weight-dependent and personal alarms. These devices have been on the market for many years. Weight-dependent alarms come in forms of bed alarms, bed pads placed under the patient, and floor pads that respond when the patient stands on them. Personal alarms are placed on the patient and are activated with a change in position that breaches the limits of the distance a patient is allowed to travel. Weight-dependent alarms are activated when the patient gets up, expecting that the opportunity to prevent a fall is minimized. An unanticipated consequence of these alarms is staff having to respond to multiple false alarms throughout a shift, adding to workload and increasing alarm fatigue, which has been identified as a serious problem by The Joint Commission. 16 With these types of personal alarms, staff is reacting to the sound of the alarm, which doesn t occur until the patient is partially or completely out of bed. The window of opportunity for rescuing the patient is too

7 narrow, and thus these reactive devices have not reduced the overall number of patient falls in hospitals, according to the data. 11 Human sitters have only proven effective if the person assigned to sit with the patient is a trained, licensed individual. Even in this scenario, some research has found a small increase in patient falls per sitter. 15 The most appropriate sitter would be a registered nurse who could utilize critical thinking and individualized care plans to monitor a patient, which is cost prohibitive in terms of salaries. In response to the high cost of paid personnel, unlicensed and untrained volunteers have been used in hospitals. 12 These range from hospital volunteer companions to the patient s own family members. Legally speaking, the responsibility for keeping patients safe cannot be transferred from the hospital to these volunteers or family members, and the organization is still liable for failure to rescue or prevent harm. These humandependent measures are, again, reactive and little evidence of the likelihood of stopping a fall actually has been published. Virtual sitters are categorized by the use of video monitoring, which require a large, upfront capital expense. These systems can include the capability of communication with the patient in the form of one-way (uni-directional) remote communication to the room to que patients to stay in bed and others can actually allow the patient to respond in a two-way (bidirectional) environment. Because it relies solely on human diligence in monitoring, this does not necessarily reduce the cost of salaried sitters, as the greater number of monitored patients requires additional personnel to safely monitor. In addition to monitoring of the video feeds, a person trained in diagnostic capabilities of patients to follow instructions would have to respond to indications of a patient s intent to rise, and the monitoring person would be obliged to stay at their post for the monitoring of the remaining patients. Generally, video monitoring is dependent

8 on the quality of the camera, and, due to cost, often the portability of the device- an assumed benefit to some organizations new to live video monitoring for patient safety- leads to more opportunity for breakage of the camera units. Many times, these devices are dependent on the wireless functionality, which uses copious amounts of bandwidth and potentially slows other operations in the healthcare setting. This reactive process does not integrate with the medical record in a meaningful way. Enhanced video monitoring may also be conveniently portable, but have all the inherent risks to the equipment from being relocated and stored: Breakage, loss, functional distance, and limited availability. If plugs and cables are required, this form of monitoring can actually cause and increased fall risk to patients and visitors. Additionally, this method requires a line of sight for monitoring and availability of personnel with accurate judgment. These cameras share other negative attributes with the video monitoring alone: they do not allow more time to respond, are dependent on the quality of the camera and wireless internet functionality, and interrupt operations of other applications by consuming large amounts of bandwidth. Once again, the process for rescuing the patient is reactionary. Healthcare workers are constantly responding to weight relief, alarm noises, or actual falls. Summarizing the available technologies to date, it is known from the literature that reactive processes do not contribute to a lower falls rate, the costs associated with falls, or the prevention of harm from falls. 6

9 Table 1 Beyond Video Monitoring: The CareView Approach Hospitals and healthcare must comply with initiatives to reduce harm, lower costs, and improve monitoring. Until recently, the only alternatives besides costly, nonproductive personal sitters or ineffective alarms, were expensive capital-intensive video monitoring systems. CareView Communications. Inc. offers the opportunity to meet the needs of the Triple Aim initiative by protecting patients from harm, protecting reimbursement, and implementing proactive solutions to at-risk patients. Barriers to effective monitoring are eliminated: the response is not reactionary, bandwidth is not necessary, and high capital investments are not required. In addition, the results are more consistent, it utilizes predictive monitoring technology rather than NO CAPITAL EXPENDITURE REQUIRED PROVIDES VALUABLE DATA human surveillance to alert staff, and is easy to monitor. Other benefits of the CareView solution include capability of integration with the electronic medical record, capturing data for

10 analysis, use of television cable that is less prone to outage, and it is predictive. The costing structure is easy to absorb into operational budgets, the technology is flexible and efficient and its predictive nature allows additional time to react and prevent falls. The single most differentiating feature is the application of Virtual BedRails and Virtual ChairRails Technology. This innovative technology is imperative in a culture of patient safety. Virtual BedRails and Virtual ChairRails are based on motion detection software that provides advance notice of a patient s intent to rise. The infrared cameras and specialized room control platforms unique to the brand combine to provide HIPAA-compliant, secure observation as needed. The early notification provides more time to respond, increasing the likelihood of successful fall prevention. The patented algorithms within the software create invisible borders around beds or chairs, and when the preset limits (defined by the trained caregiver) of the borders are breached, the caregiver is alerted immediately. This innovative, early notification system has resulted in 30-80% reduction in falls nationwide. The flexible, passive monitoring solution is not person- or place- dependent: A nurse can see the patient in real time from wherever he or she is located, and there is no requirement for a dedicated human monitor technician. The return on operating investment is very generous considering there is no capital expenditure required. Another distinguishing benefit to the Virtual BedRails and Virtual ChairRails technology available from CareView is the use of captured data. This software integrates with the electronic medical record to provide valuable data. With this platform, an analyst has the

11 capability to separate patients by type; such as ventilator dependent patients, core measures diagnoses, risk for violations of National Patient Safety Goals, and others. It can provide readily available, accurate quality data to easily measure nursing sensitive outcomes. The CareView software provides objective data, which is valuable after an event-- such as when the Virtual BedRails or Virtual ChairRails were activated, how they were placed, when they were breached, and so on. More importantly, it provides data prospectively to identify fall risk and aid in implementation of an effective care plan that supports fall prevention. Summary The link between finance and clinical priorities has never been so obvious. There are high penalties for failure to prevent harm and to recover patients who experienced untoward events in hospitals. The cost of care to treat hospital-acquired conditions is no longer reimbursable by CMS, and some states are mandating legislation on behalf of patient safety. 5,10 One fall with injury can increase length of stay, place the patient at risk for additional complications of hospitalization, and cost the system tens of thousands of dollars per event. That equals well above what CMS would have paid for the original diagnosis that initially brought the patient to the hospital. The complications of patient falls are virtually endless: CareView Communications, Inc. has the solution to patient falls. This flexible and affordable method goes beyond video monitoring for cost-effective patient safety. Virtual BedRails and Virtual ChairRails are an innovation in patient care, and the start of a culture of safety for many hospitals across the country, with a proven decrease in falls. As a game changer and a culture generator for patient safety, which is also cost effective with no capital expenditures, it is unrivaled. CareView

12 Communications has the solution: Virtual BedRails and Virtual ChairRails is the predictive technology that will make a difference in the culture of patient safety.

13 References 1. Centers for Disease Control. (2015). Important facts about falls. Retrieved from 2. Hitcho, EB, et al. (2004) Characteristics and circumstances of falls in a hospital setting: A prospective analysis. J Gen Intern Med; 19: The Joint Commission (2015). Sentinel event alert: Preventing falls and fall-related injuries in health care facilities. 2015; 55: Inouye, SK, Brown, CJ, Tinetti, ME. (2009). Medicare nonpayment, hospital falls, and unintended consequences. N Engl J Med. 360: Occupational Safety and Health Administration (n.d.). Safe patient handling. Retrieved from on December 15, Oliver, D. and Healey, F. (2009). Falls risk prediction tools for hospital inpatients: Do they work? Nursing Times. 105(7) Currie L. (April, 2008). Fall and Injury Prevention. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). Chapter 10. Retrieved from 8. Ullman, K (2014). Preventing falls curbs costs and risk. Healthcare Finance News. Retrieved from 9. Carr, F. (2013). The role of sitters in delirium: An update. Canadian Geriatrics Journal. 16: 22-36

14 10. Centers for Medicare and Medicaid Services (2014). Hospital-acquired conditions (present on admission indicator). Retrieved from Shorr, Chandler, Mion, et al. (2012). National Institutes of Health. Effects on an intervention to increase bed alarm use to prevent falls in hospitalized patients. Annals of Int Med. 157: Lake,E., Shang,J., Klaus,S.,& Durton, N. (2010). Patient falls: Association with hospital magnet status and nurse unit staffing. Res Nurs Health. 2010; 33: Gordon, D. (August 2014). Average cost per inpatient day across 50 states. Becker s Hospital Review. Retrieved from on December 16, National Quality Forum (2015). Patient safety; falls with injury. Retrieved from Spetz, J., PhD; Jacobs, J.,MD; Hatler, C., PhD, RN (2007). Cost Effectiveness of a Medical Vigilance System to Reduce Patient Falls. Nursing Economics; 25(6): Retrieved from on December 15, Pevtzow, L. (April 2013). New guidelines to reduce 'alarm fatigue.' Retrieved from on December 14, Abraham, M., MD; Cimino-Fiallos, N., MD (January 2015). Falls in the elderly. Retrieved from on December 15, 2015.