The Problem of Falls

Patient falls are a common, costly, and serious problem in hospitals and healthcare facilities. The numbers are shocking — every year, over 200,000 people fall.[i] More than 2% of hospital patients fall,[ii] with around 25% of those falls result in injury.[iii]Around 11,000 falls are fatal.[iv] These disheartening numbers are despite decades of effort to better protect patients. Falls are still one of the most common causes of harm to patients in hospitals. For these reasons, serious fall-related injuries are designated preventable Hospital-Acquired Condition by the Centers for Medicare and Medicaid.[v] CMS does not reimburse hospitals for costs related to patient falls with injury.

To us, a fall is any time a patient descends when they did not mean to.[vi] An assisted fall is a fall in which any staff member (whether a nursing service employee or not) was with the patient and attempted to minimize the impact of the fall by slowing the patient’s descent. An assisted fall is much less likely to result in injury than an unassisted fall.[vii] To improve patient recovery and outcomes, best practices today focus on increasing mobility. Nurses might encourage patients to get up and move around with supervision while they’re recovering, which can lead to the patient falling. If the nurse is there supervising the patient, they will usually be able to minimize any injury from the fall while continuing to improve the patient’s mobility. Unassisted falls, on the other hand, occur when a nurse is not there to meet the patient’s needs. Ocuvera focuses on unassisted falls, helping nurses get to patients faster and either prevent the unassisted fall entirely, or turn it into an assisted fall.

One drawback of current fall risk reduction interventions, like pressure pads and bed exit alarms, is that nurses don’t have enough time to get to the patient before they’ve gotten out of bed and possibly fallen. Addressing this limitation could help reduce falls and fall-related injuries, which decrease quality of life and increase health care costs. Nurses aren’t able to see the vast majority of patient falls as they happen, which means they don’t know what happened before the fall. Often, falls happen after a patient attempts to get out of bed on their own, events we refer to as unattended bed exits. About 45% of falls happen after unattended bed exits, 21% after unattended chair exits, and 21% happen in the bathroom, after the patient exits either the bed or the chair.[viii] Preventing the unattended bed exits that often lead to falls could have a significant impact on decreasing the falls themselves. This is what Ocuvera’s technology does, by monitoring patient movements and predicting when they are likely to attempt to get out of bed.

The problem of patient falls is complex, but it does not necessarily need a complex solution. As part of our research while developing Ocuvera, we’re pushing to have better data on patient falls to improve overall knowledge. Video is an immensely powerful tool to give insight into questions that have not had answers before – why does a patient get out of bed? What happens when they do? How often do they do it? Our technology provides nurses with literal vision into these otherwise unobserved situations, helping them better understand their patients and provide better care.

Throughout our research into falls, we have been driven by measurement, reproducible methodology, and verifiable numbers and evidence. In 2018, Ocuvera completed two state and federal grant funded studies to test the feasibility of our system to reduce unattended bed exits in rural Critical Access Hospitals in Nebraska. Figure 1 shows that unattended bed exits decreased by 89% when the system was in use. Other results from these studies showed that the Ocuvera system was able to detect unattended bed exits 96% of the time, and that 56% of the alerts sent by the system were in response to behaviors that warranted intervention from nursing staff. We found that the system alerted nurses of risky patient behavior with approximately 20 seconds of lead time.

Ocuvera began testing its field testing its system in 2017 at a neuro med-surg unit. At this site, Ocuvera has been used for over 150 of the unit’s highest-fall-risk patients and 3,000 total patient days. The unit sees approximately 7,800 patient days a year. Before Ocuvera was introduced, the unit had a high fall rate: 7.17 falls per 1,000 patient days. Since Ocuvera was introduced, the unit has seen a nearly 40% decline in falls, with a fall rate of 4.36 through July 2018. In Q4 2017, Ocuvera began another field test at one of the leading academic medical centers. Twelve cameras were used in a 50-bed med-surg unit. After 4 months, there was a 64% reduction in the number of unassisted and unobserved falls among patients where the Ocuvera system was used compared to other patients on the unit. Ocuvera was used for these patients because they were at very high risk of falling, so results could be more pronounced with broader patient selection criteria.

Our results so far are very promising. We believe they show our technology really can have an impact on the problem of patient falls by preventing unattended bed exits. We hope to conduct more studies and deploy our system to more hospitals to broaden our understanding of patient falls and how our technology can help nurses reduce them.

[i] https://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html

[ii] (Bouldin, et al., 2013)

[iii] (Oliver, Healey, & Haines, 2010)

[iv] (Agency for Healthcare Research and Quality, 2016)

[v] (Centers for Medicare and Medicaid Services)

[vi] For research purposes, we use the definition of falls from The Nati­­­onal Database of Nursing Quality Indicators® (NDNQI), which is: an unintentional descent, with or without injury to the patient, that results in the patient coming to rest on the floor, or against some other surface, on another person, or an object.

[vii] (Jones, Skinner, Kennel, & High, October 15, 2016)

[viii] (Jones, Origin of Falls, 2017)