iSixSigma

Cost of falls

Six Sigma – iSixSigma Forums Old Forums Healthcare Cost of falls

Viewing 13 posts - 1 through 13 (of 13 total)
  • Author
    Posts
  • #25514

    sixsigmadeewana
    Member

    Can anyone share how they came up with cost of a patient fall? We are trying to justify sitters for our patient fall program and I need to work on calculating the cost of a patient fall.
    My email address is [email protected]
    Thanks
     

    0
    #61574

    BritW
    Participant

    Hopefully you’ll ge the cost figure – I don’t readily have one. On another note – might want to see if your sitter program is actually reducing falls.  We found only one unit where there was a negative correlation (sitter hours up/falls down).  The rest were either non-conclusive or in two unit’s cases, the correllation was actually positive.
    I can’t find any evidence that a sitter program, onthe whole, reduces falls or betters fall rate.  FYI.  If you find evidence, please post.

    0
    #61575

    sixsigmadeewana
    Member

    Our “sitter” program showed significant improvement. Here is a summary of what we tried
    1. Screen patients for potential to fall
    2. Assign the patients to the “sitter” or “searcher” (as we called them)
    3. Searcher rounds every 15-20 mins and offers help for toilet and moving.
    This program reduced the average falls from 6 per month to less than 1 on the pilot unit.
    I can provide more details if needed.
     

    0
    #61576

    D.Salmain
    Participant

    Dear Mr. Britw,
    Can you share with us how you calculate the correlation? What type of data we should gather?
    Thanks.

    0
    #61579

    Thomas Wyatt, Ph.D., CPHQ
    Member

    I may be oversimplifying here but, if the question concerns, for the most part, financial costs, would it not be appropriate to treat the situation as comparable to any cost/benefit analysis problem?
    Initially, a pilot study could be done, first using retrospective data from the medical records of a small, random sample of recent fall patients.
    Both direct and indirect financial costs, both to the patients and to the HCO, that were incurred as a direct result of the fall could be calculated from patient billing records and the HCO’s cost accounting system.
    From that pilot study, preliminary conclusions could possibly be drawn as to mean costs in direct and indirect patient services, HCO fixed costs, and extended LOSs as a result of a fall.
    It might be possible to also get some ideas of any commonalities or correlational issues associated with falls, such as DRGs, locations of falls, times, & etc.
    The pilot study findings might require a more comprehensive followup study or might be sufficient in themselves to make a case.

    0
    #61580

    sixsigmadeewana
    Member

    The idea sounds reasonable, but I wanted to know if there is any approach which can help me maximize the cost. Apart from any post-fall intervention costs, is there any other cost that I should consider in the analysis ? I want to show the maximum possible cost associated with any fall.
     

    0
    #61581

    Thomas Wyatt
    Member

    You could include the costs, direct and indirect, that are associated with any extension of the LOS.
    Then, there are the far less tangible or theoretical monetary issues that can come about if the incident is notable enough to require a quality and/or risk management investigation. And, of course, there’s the possibilties of liability issues should the injury be severe or life-threatening.
    For example: say an elderly patient comes in for a relatively common or minor procedure, like an appendectomy or lap-chole. She’s expected to make a full recovery and stay in-house for a couple of days. On the second post-op day, she wakes at 2:00 a.m. and attempts to walk from her bed to the restroom and falls, breaking her hip.
    In addition to extra service costs, such an accident, in and of itself and with no sequelae like pnemonia or wound infection, could result in an expensive lawsuit, legal fees, insurance hikes, and bad publicity.
    While the scenario may be speculative, the costs of such disasters can nevertheless be researched and legitimately presented (with the proper citations of course). Such graphic examples that threatens the pocketbook of administrators might help in making your case

    0
    #61582

    Jonathon Andell
    Participant

    You’ve had some good posts, and I agree to a point. I tend to think of a sitter as more of a containment measure than true prevention. If you believe I am right, then the sitter should be an interim measure until you develop an effective, non-FTE solution.
    As for costs, you may want to consider an Excel-based Monte Carlo model, accounting for the following sources of variation: frequency of falls, patient acuity prior to fall, severity of fall, and so on. Many Monte Carlo models allow you to account for how those factors may be correlated.
    Some costs to consider may include increased LOS, extra person-hours of care, paperwork, incremental supplies. Bear in mind that the biggest costs of reputation, satisfaction, etc., are the hardest to quantify, but I am confident that the portion you can count will be substantial.

    0
    #61585

    sixsigmadeewana
    Member

    Frankly, I have not seen any fall prevention program which has reduced falls signigficantly without adding sitters.
    Programs like falling star, workplace re-organization, alarms are ways of reducing falls but not preventing falls.
    If anyone knows about a tried and tested technique which works and does not involve FTE, please post.

    0
    #61586

    BritW
    Participant

    Not to burst the bubble – but I haven’t seen anything that shows sitter hours have any positive effect on falls.  Try doing an analysis in your organization by unit – bet you dont’t find that high negative correlation between hours and falls or fall rate/1000 pt days.  I know I didn’t.   Restraints were the answer, but not legal anymore.  One thing we are trying is the removal of all non-scope practice from the nurse and moving to someone else – allowing the nurse to be at the bedside more often.  Also doign the falling star, redesign, et al, but nothing seems to be a catch-all. 
    Is there a possibility that we cannot get to 5 or 6 sigma with this particular problem?  Just posing the question…

    0
    #61587

    sixsigmadeewana
    Member

    I think the way you use the sitters makes a difference. What worked for us is rounding on patients every 15-20 mins. So you dont need 1 sitter per patient, but 1 sitter or rounder per floor. We tried it for 2 months and showed decrease in falls from 6 per month to 1 per month.
    Freeing up the nurses is probably the best approach, but with the amount of paperwork/forms and documentation, it could be hard.
    You could get 5 or 6 sigma with this approach….its a matter of how much you are willing to spend on it…..

    0
    #61588

    BritW
    Participant

    Did you have a sitter round 24/7?

    0
    #61589

    sixsigmadeewana
    Member

    Yes…we had them round 24/7….we had 1 sitter per shift for entire floor…Pilot floor had 2 units with a total of 30 beds….Our census for those 2 months was not significantly different than other months…
     

    0
Viewing 13 posts - 1 through 13 (of 13 total)

The forum ‘Healthcare’ is closed to new topics and replies.