Do No Harm: A Multifactorial Approach to Preventing Emergency Department Falls-A Quality Improvement Project.

INTRODUCTION: Patient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital.

METHODS: This project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure.

RESULTS: After data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries.

DISCUSSION: A multifactorial approach was an effective strategy to decrease patient falls in the emergency department.