Hospital Fall Prevention Using Interactive Patient Care Technology

Purpose:

The purpose of this investigation was to examine the engagement of hospitalized patients in a computer-based, interactive patient care fall prevention pathway, comprised of a self-assessment of fall risk questionnaire and a fall prevention video, and hospital fall outcomes. A specific aim was to explore the relationship between the fall prevention pathway engagement characteristics and a fall outcome in an acute care hospital. The Interactive Patient Care Technology conceptual framework was created to guide the investigation.

Methods:

The study took place in a non-profit, community hospital located in southern California. The hospital deployed interactive patient care (IPC) technology to improve the patient experience and organizational goals. Interactive patient care technology leveraged the hospital room television and bedside remote device to deliver health related messages and educational content and engage patients in their care. Human subjects’ protection was obtained through the study hospital’s Institutional Review Board. A matched, 1:4 case-control design using 73 cases and 292 controls was applied to examine the relationship between the fall prevention pathway engagement characteristics and a fall outcome. Subjects who fell comprised the cases and subjects who did not fall were the controls. Retrospective data from patients receiving acute care services over a two-year period and who met inclusion criteria was abstracted from the hospital’s three electronic documentation systems including the electronic medical record, IPC computer database, and incident reporting system. Subjects included in the study were adults  ≥ 18 years of age; alert and oriented to person, place, time, and situation; English speaking; determined at risk for falling by a registered nurse using the hospital’s fall risk assessment instrument; and admitted at least 18 hours. Controls were matched to cases based on patient care unit and gender, then range matched to ± 5 on age and hospitalization admission date. Subject demographics, IPC fall prevention pathway engagement characteristics, and fall status comprised the variables collected. Subject and IPC engagement characteristics of the cases and controls were described using frequency distributions. Conditional logistic regression was used to examine the association of subject and IPC engagement characteristics with the outcome of hospital fall. To examine the association of dichotomous variables, the Mantel-Haenszel test was applied.

Results:

Range matching on age was performed to within ±5 years with the mean almost identical between the cases (62.5, SD = 16.1) and controls (62.6, SD = 15.8). Cases and controls were mostly white and not married. The average length of stay for cases was 8.1 days (SD = 6.5) and for controls was 6.1 days (SD = 4.7). Self-assessment of fall risk questionnaire:  A majority of cases and controls received the maximum programmed amount of IPC prompts (messages) to complete the self-assessment of fall risk questionnaire and responded to one or more of the prompts. The questionnaire was completed by 9 (12%) cases and 37 (13%) controls. The mean age of cases was 64.7 (SD = 10.1) and controls was 58.3 (SD = 16.0). The highest prevalence was in females (cases 56%, controls 54%) and in acute care (cases 78%, controls 62%). A majority of cases and controls completing the questionnaire received one invitation prompt, acknowledged one prompt, and submitted a final response to the first prompt delivered. Fall prevention video: A majority of cases and controls received the maximum programmed amount of prompts to watch the fall prevention video and responded to one or more of the prompts. The video was completed by 12 (16%) cases and108 (37%) controls. The mean age for cases was 67.7 years (SD 10.7) and for controls was 62.9 years (SD 15.3). A majority of the cases were male (67%, n = 8) whereas controls were female (59%, n = 64). A majority of cases and controls completing the video acknowledged up to three prompts, and submitted a final response with either the first, second, or third prompt delivered. Fall outcome: Conditional logistic regression examined if the fall prevention pathway engagement characteristics were associated with a fall outcome. Subject and IPC engagement characteristics were used in the analysis based on the conceptual framework and univariate and correlational analyses. The overall model was statistically significant, likelihood ratio χ2 = 28.17 (4), p = .001. Length of stay, number of video prompts, and fall prevention video completion status were significantly associated with a hospital fall. As length of stay increased by one day, the odds of a fall were 11% higher. With each additional video prompt delivered the odds of a fall increased by a factor of 1.58. Cases were .38 times less likely to complete the fall prevention video than to complete it. The association between the self-assessment of fall risk questionnaire completion and video completion was not statistically significant. 

Conclusion:

Interactive patient care technology can augment an organization’s safety efforts. A computer-based, interactive fall prevention pathway promoted patient engagement. Engagement at the empowerment level of the conceptual framework - when the fall prevention video was completed, prevented a fall. Healthcare providers can facilitate IPC technology, patient engagement and fall prevention by assessing and removing barriers to video completion and partnering with patients in executing a safety plan. Limitations of this investigation included the use of secondary data, subject related assumptions, and the inability to generalize due to site, technology, and sample. This investigation contributes new knowledge regarding patient engagement in hospital fall prevention using interactive patient care technology.