Reducing Patient Falls – A Case Study
The Joint Commission Journal on Quality and Patient Safety (Feb 2018) has an article entitled “Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program.”
I believe the story could have been told easily with quality improvement tools, so here’s how I’d go about it. First, there are a number of tables (i.e., spreadsheets of performance data) like the one below.
The first year, 2003, had only 200 falls because they started measuring in July. The first full year of measurement was 2004.
It would be easy to turn these into control charts, but the authors chose a boxplot with a trend line of predicted falls.
The boxes, whiskers and outliers are so dense that they make this chart unreadable. In world of data visualization, many would consider this to be “chart junk.”
What if we used an XmR chart of falls per year and “ghosted” the first point? A number of improvements from 2004-2009 seemed to reduc the rate. Hourly rounding in 2010 resulted in the biggest reduction. Subsequent improvements did not affect the falls rate.
Now we can look at some of the types and locations of falls. Here’s the data. Again, it’s a spreadsheet that’s a bit hard to read.
What if we used Pareto charts to narrow the focus? 40-79 year olds fall most frequently (there may be fewer 80+ year old patients).
Most falls occur in surgical or step down (between ICU and surgical) units. This would be an easy way to laser focus improvements to reduce falls.
Of course, this data is spread over 11 years, so we don’t have the data to analyze recent performance, but I’m sure it exists. Maybe it would help identify what kind of patient falls in what kind of unit. Other data I have seen found that male, orthopedic surgery patients between 20-40 years of age suffered the most falls.
Authors sometimes complicate their analysis for journals as if it’s a requirement for publication. What if we got back to telling improvement stories with a few more charts and a lot fewer words?
Jay Arthur teaches people how to Turn Data Into Dollars® using Microsoft Excel and the Magnificent Seven Tools of Quality. He is the author of Lean Six Sigma for Hospitals and the QI Macros® software. www.qimacros.com, jay@qimacros.com, 303.756.9144
Jay, you often talk about meaningful data and I think you nailed it here. Meaningful data must be able to add value to the story you're trying to tell. I think some folks simply throw a chart up in a presentation because they felt the need to show a chart- and tha's unfortunate.
Really instructive!