Issue/Problem of Interest
Falls are the second most common adverse event within health care institutions following medication errors, and an estimated 30% of hospital-based falls result in serious injury. The severity of this problem led the Joint Commission to make reducing the risk of patient injuries from falls a national patient safety goal for hospitals in 2009 (AHRQ, 2006). Falls are a leading cause of hospital-acquired injury and frequently prolong and complicate hospital stays and result in poor quality of life, increased costs, and unanticipated admissions to long-term care facilities.
Changes in health care financing in the 1990s were accompanied by a variety of cost-cutting measures in hospitals across the United States. Common cost-cutting strategies included reducing the total number of nursing hours per patient day and reducing the percentage of hours supplied by registered nurses (RNs), the most highly paid group. The reduction in staffing led to widespread concern that patient care in acute care settings would suffer.
In response to concerns about staffing and quality of care, the American Nurses Association (ANA) launched the Patient Safety and Nursing Quality Initiatives in 1994 to address the impact of health care restructuring on patient care and nursing. To facilitate the initiative, ANA established the National Database of Nursing Quality Indicators (NDNQI) in 1997, with two goals: (1) to develop a database that would support empirical monitoring of the impact of nurse staffing on patient safety and quality of care across the nation, and (2) to provide individual hospitals with a quality improvement tool that includes national comparisons of nurse staffing and patient outcomes with similar hospitals (Hart and Davis, 2010).
Patient falls impact hospitals both financially and in regulatory body status. In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the prevalence of life-threatening conditions acquired by patients in U.S. hospitals, Congress authorized the Centers for Medicare and Medicaid Services (CMS) to implement payment changes designed to encourage the prevention of such conditions. Under an amendment to the Social Security Act that was enacted on January 1, 2007, the secretary of Health and Human Services was required to identify at least two hospital-acquired conditions by October 1, 2007, that were high-cost, high-volume, or both; that resulted in the assignment of a case to a higher-paying diagnosis-related group (DRG) when they were present as a secondary diagnosis; and that could reasonably be prevented through the application of evidence-based guidelines (New England Journal of Medicine, 2009).
The CMS worked collaboratively with the Centers for Disease Control and Prevention (CDC) and on October 1, 2008, enacted new payment provisions: Medicare will no longer reimburse hospitals for a higher-paying DRG when one of eight...