Introduction
Patient falls have been documented as a major area of concern for health institutions and the public due to the adverse outcomes associated with the incidents. Available literature demonstrates that patient falls may result in patient death and disability, pain, exposure to expensive lawsuits, and associated financial costs (Spetz, Brown, & Aydin, 2015). This paper analyzes a research article on preventing patient falls with the view to gaining important insights into how its findings can be used to change nursing practice on the issue.
Research Question
Although the article is not guided by an explicit research question, its underlying justification is premised on the fact that some prevention programs aimed at reducing hospital falls are not successful despite the substantial investments made to develop and implement them (Spetz et al., 2015). Since the article under analysis attempts to present a model that could be used by nursing professionals to evaluate the cost savings resulting from implementing a falls-prevention program, the implied research question can be stated as follows: will the implementation of a falls-prevention program help in reducing hospital costs?
Research Design
The study employed a systematic review research design as demonstrated by the fact that the researchers used data from published research articles and CALNOC database to assess several variables, such as hospital fall rates and impacts of intervention, cost of hospital patient falls, and costs of hospital patient falls-prevention programs (Spetz et al., 2015). The evaluation of previous research studies on hospital falls provided useful insights on the overall effectiveness of interventions that were of interest to the studies. This research design enabled the researchers to amalgamate, summarize and review findings of published research studies and other sources of data with the view to developing precise estimates on fall rates, impacts of falls-prevention interventions, cost of hospital patient falls, and costs of hospital falls-prevention programs.
Sampling and Participants
The sample for the study included published research studies on falls-prevention programs that were sourced from the PubMed database. Although the study is not clear on the number of published studies that comprised the final sample, research articles were included in the study if they (1) supplied unambiguous data on both the pre-intervention and post-intervention fall rates, (2) listed the number of health institutions consulted in assessing the effectiveness of the interventions, and (3) identified the categories of patient care units or departments included in the study (Spetz et al., 2015). It is impossible to comment on whether the sample was adequate as the sample size is not indicated in the article; however, it is important to note that a systematic review design calls for absolute coverage of all the relevant data and studies to ensure that the ensuing statistical analyses can provide a true picture on the effectiveness of a particular intervention.
Data Collection Methods
A meta-analysis was conducted on published studies to synthesize relevant data and present a balanced and unbiased synopsis of the existing research on hospital inpatient fall rates and impacts of interventions, cost of hospital patient falls, and costs of hospital patient falls-prevention programs (Spetz et al., 2015). The researchers also collected data on patient fall rates from the CALNOC database with the view to comparing them with the data sourced from the sampled published research studies. The researchers were mostly concerned with collecting data “on improvements in hospital fall rates, costs of falls, and costs of prevention programs to estimate the net savings from investment in falls prevention” (Spetz et al., 2015, p. 53). As such, the data collected were used to test the return on investment (ROI) of a simple model that could be used by nursing professionals to prevent hospital falls.
Limitations of the Study
One of the limitations of the study is that the researchers “assumed that hospitals will achieve improvements in fall rates through active prevention efforts” (Spetz et al., 2015, p. 55). However, this is not the case as demonstrated by the fact that the effectiveness of falls-prevention programs is influenced by factors such as patient population and the types of interventions implemented in healthcare settings. Subsequent studies can overcome this limitation by considering these factors in the design phase. Another limitation is grounded in the cost inconsistencies of various fall treatment and prevention programs that formed the basis of evaluation in the published research studies. This limitation can be addressed in subsequent research studies by using hospital-specific indicators to calculate costs and hence ensuring that factors such as local costs of labor and equipment, regulatory fines for adverse patient outcomes, and legal expenses are put into consideration.
Study Findings
The study found that falls-prevention programs in hospital settings can only attain cost-effectiveness if the investments made toward such programs are reasonably small. The study also found that the cost savings a health institution achieves from implementing a falls-prevention program are dependent on “the reduction in falls rates attained, the hospital’s historic costs of caring for patients after fall, the hospital’s non-reimbursement rates for hospital-acquired conditions, and the amount spent on prevention activities” (Spetz et al., 2015, p. 55). An analysis of the expected cost of falls before the implementation of a falls-prevention program and the post-intervention cost showed that hospitals can achieve cost savings by implementing the programs. However, these cost savings are diluted by the actual costs of implementing the fall programs, meaning that hospitals must reduce the expenditures associated with implementing the programs if they are to achieve significant cost savings.
Additionally, the study found that “prevention programs are cost-saving if the cost of prevention is at the minimum, and also if prevention costs are at the average and treatment costs are at the average or maximum” (Spetz et al., 2015, p. 55). This means that health institutions with fewer inpatients are often unable to benefit from falls-prevention programs as the money collected from patient volumes cannot offset the costs associated with implementing and managing falls-prevention programs. Overall, it is clear that the research question is satisfactorily answered as the study findings show some of the ways that could be used to ensure the cost-effectiveness of a falls-prevention program.
Summary of Article
Informed by the need to address the adverse outcomes associated with patient falls, the study under review used a systematic review research methodology and a meta-analysis data collection procedure to evaluate the cost savings associated with implementing falls-prevention programs in inpatient healthcare settings. The findings are clear that falls-prevention programs in hospital settings can only attain cost-effectiveness if the investments made toward such programs are justifiably small. The evidence so far accumulated from this article is enough to suggest a change in practice, from using traditional approaches to develop falls-prevention programs to ensure that such initiatives are developed and implemented around unique factors that will ensure cost-effectiveness in reducing hospital costs. For falls-prevention programs to be effective in reducing hospital costs, nurse leaders must consider factors such as patient fall costs, lawsuit costs triggered by patient falls, patients who are likely to benefit from the program, patients at greatest risk of falling in healthcare settings, and enhancement of patient function and quality of life.
Reference
Spetz, J., Brown, D.S., & Aydin, C. (2015). The economics of preventing hospital falls: Demonstrating ROI through a simple model. Journal of Nursing Administration, 45(1), 50-57.