Reducing inpatient falls: Human factors & ergonomics offers a novel solution by designing safety from the patients’ perspective

Patients feel safe in the hospital and perceive they are less likely to fall whereas the opposite can be true if weakness, confusion and/or altered elimination issues are experienced as a result of symptoms, medication and/or procedures. A previous editorial from Grealish and Chaboyer (2015) outlined the scale and scope of this problem with an excellent argument for improving nursing care by valuing essential needs including ambulation, hydration, nutrition and elimination. However, despite many interventions (and models of nursing care) to improve assessment, monitoring and communication (Hignett, 2010), there has been little evidence of sustained reductions in either the number of falls or severity of injuries over the last 60 years (Oliver et al., 2007)

Taking a human factors systems approach to slip, trips and falls risks in care environments

Taking a human factors systems approach to slip, trips and falls risks in care environment

Embedding human factors & ergonomics in healthcare with building design at the centre of the system

Background: Risk factors for patient slips, trips and falls (STF) have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness and so many of the interventions over the last 60 years have focussed on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Purpose: To use a theoretical model for HFE (DIAL-F) and a comparison with occupational STF risk management to discuss patient STF interventions. Methods: Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (1) a design-based (building) approach to embed safety into the built environment; (2) a staff (and organisation)-based approach; and (3) a patient behaviour-based approach to explore and understand patient perspectives of STF events. Results: The results from the case studies suggest that there will be benefits from taking a as HFE approach similar to other industries, i.e. a sustainable design intervention for the person who experiences the STF event - the patient. The DIAL-F model supports a change in bedside interventions from a passive model of providing care and treatment (analogous to a production line with inanimate components) to an active model representing independent functional activities with changed physical, cognitive and behavioural capabilities. The challenge is to design inclusive interventions to benefit a range of patients that do not introduce barriers or problems for staff and other system stakeholders. For example poor balance linked to rising from a chair might be assisted by building and technology design solutions, or not using an out of reach assistive device could be addressed by providing accessible equipment and timely assistance. Conclusions/implications: As over 70% reported patient STF are un-witnessed and research indicates there are benefits from retaining mobility associated with continence, cognitive function and pressure care there is an argument to design STF interventions to support patient mobility and autonomy. Rather than continuing to fight this seemingly intractable problem with complex packages of care, we suggest it is time to look proactively at this problem with an HFE approach to facility design and other interventions that include the perspective of all the stakeholders

Ending the vicious cycle of patient falls

Over the past two years Barnes-Jewish Hospital has used Lean and Six Sigma methodologies in process improvement projects to prevent inpatient falls and falls with injury. These intensive programs have validated that falls are a multifaceted, complex problem that need constant vigilance and continuous improvement to sustain patient safety. Falls that result in serious injury can be life-changing for patients and families as well as impact the caregivers with potentially severe financial and health consequences. Trends in fall rates after completion of two Case Studies show that while decreasing the number of falls continue to be a challenge; the severity of injury from a fall can be reduced with patient and staff collaboration

What is the relationship between human factors & ergonomics and quality improvement in healthcare?

© 2015 Taylor & Francis.A recent initiative in the National Health Service (NHS, UK) has led to an increased interest in Human Factors & Ergonomics (HFE). As part of initial discussions there have been questions about the similarities and differences between HFE and Quality Improvement (QI).We believe that there are considerable advantages from a more structured relationship between HFE and QI in healthcare and have comparatively mapped a range of dimensions (origins, drivers, philosophy, focus, role and methods). Our conclusion is that HFE in healthcare should use four criteria to maximise the benefits from this opportunity, including the use of HFE methods to design systems, environments, products etc. and the direct involvement of qualified (chartered) HFE professionals

Human factors & ergonomics and quality improvement science: integrating approaches for safety in healthcare

Introduction: In this paper, we will address the important question of how quality improvement science (QIS) and human factors and ergonomics (HFE) can work together to produce safer solutions for healthcare. We suggest that there will be considerable advantages from an integrated approach between the two disciplines and professions which could be achieved in two phases. First, by identifying people trained in HFE and those trained in QIS who understand how to work together and second, by developing opportunities for integrated education and training. To develop this viewpoint we will: Discuss and explore how QIS and HFE could be integrated by building on existing definitions, scope of practice, knowledge, skills, methods, research and expertise in each discipline. Outline opportunities for a longer-term integration through training, and education for healthcare professionals

Balancing the complexity of patient falls: implementing quality improvement and human factors/ergonomics and systems engineering strategies in healthcare

Introduction: Falls are the leading cause of death due to injury among the elderly. Every 24 minutes an older adult dies from a fall related injury. Studies using 3 different methods were performed at a large urban, academic medical center in the US. Aim #1: Understand the advantages and disadvantages of QI methodologies (Lean and Six Sigma) and HFE when applied to fall prevention in the acute care setting: o Evaluate the contribution of QI and HFE to fall prevention with a focus on reducing falls with serious injury. o Use studies with different methodologies (Lean, Six Sigma) to develop and implement an intervention with the goal of decreasing total falls and falls with injury. o Compare methodologies (Lean, Six Sigma and HFE) to understand their benefits and limitations. Aim #2: Develop recommendations for fall prevention: o Investigate interventions and assess success of fall prevention. o Develop an understanding of interventions that prevent falls resulting in injury. Methodology and Results: Study #1 (Method = Lean, Intervention = Standard Work): Study #1 used Lean techniques such as standard work to improve fall risk assessment and intervention selection. Total falls decreased by 22%. At first glance this appears successful but a deeper evaluation of the serious injuries revealed more improvement is needed. There were still 15 falls with serious injuries that occurred among the three oncology divisions. These rare but serious injuries result in a longer hospital stay and increased cost of treatment that is not reimbursed. Due to a climate of increasing financial pressure further reduction of serious injury was desired. Study #2 (Method = Six Sigma, Intervention = Patient Partnering: Study #2 used Six Sigma tools to investigate root causes of falls. An intervention called Patient Partnering was developed to encourage patients to call for help and participate in preventing their own falls. There were no falls with serious injury for over 14 consecutive months. However, the intervention was difficult to sustain due to resistance from nurses and patients. Falls with injuries resumed as the intervention ceased. Study #3 (Method = Qualitative HFE, Intervention = Patient Interview): Study #3 was a qualitative study based on Human Factors principles to understand patient s perception of fall risk. It was found that patients did not think they would fall and felt particularly safe and protected while in hospital. They found it difficult to get around with IV tubes and crowed spaces. They wanted information and assistance when they need it, in the format they prefer (customized for each individual patient). Impact on society: Falls prevention interventions need to be designed for all the stakeholders (patients and staff). Patients think nurses will keep them safe and are willing to participate with fall prevention if they feel it is tailored to their needs. Until all perspectives are taken into account it is unlikely that there will be sustained and embedded improvements. Key message: Falls with injury are rare events with complex root causes that require agile solutions with constant revision to align with rapidly changing conditions and interactions. Reducing injury will take a balance between safe environment, organization, processes, tasks and behaviors from staff and patients

Human Factors and Ergonomics and Quality Improvement Science: Integrating Approaches for Safety in Healthcare

In this paper, we will address the important question of how quality improvement science (QIS) and human factors and ergonomics (HFE) can work together to produce safer solutions for healthcare. We suggest that there will be considerable advantages from an integrated approach between the two disciplines and professions which could be achieved in two phases. First, by identifying people trained in HFE and those trained in QIS who understand how to work together and second, by developing opportunities for integrated education and training. To develop this viewpoint we will: Discuss and explore how QIS and HFE could be integrated by building on existing definitions, scope of practice, knowledge, skills, methods, research and expertise in each discipline; Outline opportunities for a longer-term integration through training, and education for healthcare professionals