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Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention: The Importance of Time Nurses Spend
Teryl K Nuckols1, Jack Needleman, Tristan R Grogan
1Author Affiliations: Director (Dr Nuckols), Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles; Health Services Researcher (Dr Nuckols), RAND Corporation, Santa Monica; Principal Statistician (Ms Grogan), Associate Professor (Dr Liang), Hospitalist (Dr Czypinski), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles; Professor (Dr Needleman), Research Assistants (Mss Anderson and Coles), UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles; Evidence Implementation Nurse Specialist (Ms Worobel-Luk), Institute for Nursing Excellence, UCSF Medical Center, San Francisco; and Accreditation Manager (Ms Walsh), Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, California.
Objective:
The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals.
Background:
Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions.
Methods:
We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year.
Results:
Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities.
Conclusions:
Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.
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