EXECUTIVE SUMMARY
A Florida hospital has reduced falls in common areas by 16%. A team studied incident reports and implemented several simple changes to policies and the facility.
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The project was aimed at common areas rather than patient care areas.
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Simple physical modifications had significant effects on safety.
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The Changes Were Cost-effective When Compared To The Costs Of Falls.
Determined to reduce slips, trips, and falls in common areas, a safety team at St. Joseph’s Hospital in Tampa, FL, studied incident reports to determine the most common causes and potential solutions. After implementing several mostly simple safety initiatives, the hospital saw a 16% reduction in falls from the previous year.
The project arose after hospital leaders realized that a significant number of slips, trips, and falls were occurring in common areas of the hospital campus such as lobbies, waiting rooms, stairwells, sidewalks, and parking garages. Past efforts to reduce falls in patient care areas had not specifically addressed these common areas, and in 2012 the risk management department contacted facilities manager David D. Miller to express concern that there recently had been a dozen falls in one of the hospital’s parking garages, including some that led to litigation.
Falls are costly, with the Centers for Disease Control and Prevention (CDC) estimating that costs tied to hospital falls average $35,000 per incident. (Information is available at http://tinyurl.com/mf3ua5j.)
An investigation found that about 60% of falls in the hospital’s parking garages were people tripping over the concrete car stops at each parking space. Miller researched the building code in Tampa and found that car stops were not required in parking garages except for the spaces on the perimeter of each floor. Miller had all the unnecessary car stops removed and eliminated that tripping hazard.
That change led to Miller thinking about what other changes might be needed on the 35-acre campus, which led to him working with risk management to hire a consulting company for a pedestrian accommodation survey. The company produced a report with more than 50 recommendations, and St. Joseph’s implemented most of them. These were some of the significant changes:
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At pedestrian crosswalks, the hospital prohibited cars from parking on either side. Cars parked close to the crosswalk might shield pedestrians from drivers’ view as they step into the street.
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The hospital removed shrubs and other vegetation from entrances and exits to the parking decks, to avoid blocking drivers’ view of pedestrians.
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The hospital changed speed bumps to speed tables, which have a gradual incline and a flat plateau and then a gradual decline. Several falls at St. Joseph’s were attributed to people tripping over the speed bumps.
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The hospital installed a mid-block pedestrian crosswalk at a point where people were crossing a four-lane road instead of going to the corner crosswalk.
Still seeing room for improvement, Miller formed the Non-Patient Care Slip and Fall Committee in late 2012 that included himself and representatives from risk management, safety and security, and environmental services. He obtained the hospital’s slip and fall data from non-patient care areas for the previous five years, and the committee studied them for evidence of falls that could have been prevented. The committee met monthly, reviewed any falls from the previous month, and visited the location of the fall to look for possible solutions.
Most of the remedies were fairly simple and inexpensive. Where people were walking off a sidewalk edge because they were busy looking at their phones, the committee installed a yellow chain on the sidewalk to get people’s attention. When there were falls in the cafeteria from ice melting on the floor, they installed mats in front of the ice machine. Falls also occurred in the cafeteria when people spilled their coffee or soft drinks, so the hospital provided lids at the cashier and instructed the cashiers to encourage people to use them.
One of the most influential changes at St. Joseph’s, Miller says, was the installation of pop-up safety cones and paper towel dispensers in elevator lobbies and many other common areas. Next to the paper towels and cones are signs that say, “If you see a spill, don’t pass it up. Wipe it up.” The slogan was promoted through in-house publications and other employee communications.
“The biggest concern we got was that our staff didn’t know what they were cleaning up, and so they didn’t want to touch it. We told them to just put a paper towel on it, put a cone on top of it, and call housekeeping,” Miller says. “Then we led by example. I do rounds weekly with the president of the hospital, and we use the supplies every time we see a spill.”
Other changes included the following:
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Lighting was improved in parking lots and parking garages.
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Crosswalks with amber flashing lights were installed in parking decks.
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Walk-off mats and umbrella holders with plastic bags were provided at all entrances.
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After several falls in parking deck stairwells, the hospital posted signs at each landing encouraging people to use the handrails.
A year after the committee’s changes, falls in non-patient care areas were down 16%, from 46 in 2012 to 35 in 2013.
“None of the changes were all that creative or groundbreaking, but we found that you can make a real difference with attention to the details,” Miller says. “The changes also were not costly in most cases, and the expenses were more than offset by the savings from the fall reduction.”
