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Sosa MA, Soares M, Patel S, Trujillo K, Ashley D, Smith E, Shukla B, Parekh D, Ferreira T, Gershengorn HB. The Impact of Adding a 2-Way Video Monitoring System on Falls and Costs for High-Risk Inpatients. J Patient Saf 2024; 20:186-191. [PMID: 38345404 DOI: 10.1097/pts.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVES We aimed to investigate the value of adding a video monitoring (VM) system with falls and costs for patients at high risk. METHODS We conducted a retrospective, historically controlled study of adults (≥18 y old) at high risk of fall admitted at the University of Miami Hospital and Clinics from January 1 to November 30, 2020 (pre-VM) and January 1 to November 30, 2021 (post-VM); in-person sitters were available in both periods. Fall risk assessment was conducted on admission and at every nursing shift; we defined patients as high risk if their Morse Fall Scale was ≥60. We conducted a multivariable logistic regression model to evaluate the association of period (pre- versus post-VM) with falls and performed a cost analysis. RESULTS Our primary cohort consisted of 9,034 patients at high risk of falls, 4,207 (46.6%) in the pre-VM and 4,827 (53.4%) in the post-VM period. Fall rates were higher in the pre- than the post-VM periods (3.5% versus 2.7%, P = 0.043). After adjustment, being admitted during the post-VM period was associated with a lower odds of fall (odds ratio [95% confidence interval], 0.49 [0.37-0.64], P < 0.001). The median adjusted hospital cost (in 2020 dollars) was $1,969 more for patients who fell than for patients who did not (interquartile range, $880-$2,273). Considering start-up and ongoing costs, we estimate VM implementation to partly replace in-person monitoring has potential annual cost savings of >$800,000 for a hospital similar to ours. CONCLUSIONS Video monitoring to augment in-person sitters is an effective fall prevention initiative for patients at high risk of falls, which is likely also cost-effective.
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Affiliation(s)
- Marie Anne Sosa
- From the Department of Medicine, University of Miami Miller School of Medicine
| | - Marcio Soares
- From the Department of Medicine, University of Miami Miller School of Medicine
| | - Samira Patel
- Quality Department of the University of Miami Hospital and Clinics, Miami, Florida
| | | | - Doreen Ashley
- Nursing Department of the University of Miami Hospital and Clinics
| | - Elizabeth Smith
- Nursing Department of the University of Miami Hospital and Clinics
| | - Bhavarth Shukla
- From the Department of Medicine, University of Miami Miller School of Medicine
| | - Dipen Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Tanira Ferreira
- From the Department of Medicine, University of Miami Miller School of Medicine
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Kondo S, Inoue T, Saito T, Kawamura Y, Katayama A, Nakamura M, Sumitani R, Takahashi M, Oura M, Sogabe K, Harada T, Fujii S, Nakamura S, Miki H, Kagawa K, Sato N, Ono R, Abe M, Katoh S. Allogeneic haematopoietic stem cell transplantation and patient falls: impact of lower extremity muscle strength. BMJ Support Palliat Care 2022:bmjspcare-2022-003582. [PMID: 35534187 DOI: 10.1136/bmjspcare-2022-003582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVES Patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) have a higher risk of falls than those receiving other therapies for haematological disorders. This study aimed to investigate the impact of pretransplant lower extremity muscle strength (LEMS) on post-transplant falls. METHODS In this retrospective cohort study, patients aged ≥18 years who underwent allo-HSCT were included. All data were extracted from medical records. LEMS was defined as the knee extension force measured by a handheld dynamometer divided by the patient's weight. The receiver operating characteristic (ROC) curve was used to calculate the optimal LEMS cut-off value for prediction of falls. Patients were categorised into low and normal LEMS groups based on the cut-off value. The impact of pretransplant LEMS on post-transplant falls was analysed using a Cox proportional hazards model. RESULTS In total, 101 patients were analysed. During the observation period, falls occurred in 32 patients (31.7%). The ROC curve analysis results showed that the optimal LEMS cut-off value for prediction of falls was 45.4% per body weight. In multivariate analysis, pretransplant low LEMS was a significant predictor of falls in model 1 with patient characteristics as a confounding factor and model 2 with medications-inducing falls as a confounding factor, respectively (model 1: HR 3.23, 95% CI 1.37 to 7.64; model 2: HR 2.82, 95% CI 1.20 to 6.59). CONCLUSIONS Pretransplant LEMS was a significant predictor of post-transplant falls. The results of this study may help to prevent falls in patients undergoing allo-HSCT.
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Affiliation(s)
- Shin Kondo
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Takashi Saito
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Yuka Kawamura
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Ayane Katayama
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Nakamura
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Ryohei Sumitani
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Mamiko Takahashi
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Masahiro Oura
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Kimiko Sogabe
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Takeshi Harada
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shiro Fujii
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shingen Nakamura
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirokazu Miki
- Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Tokushima, Japan
| | - Kumiko Kagawa
- Department of Hematology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Nori Sato
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Masahiro Abe
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities, Tokushima, Japan
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