Project Design, Methods, and Budget: Patient Falls

With the growing number of older adult patients in the US, the problem of their management becomes critical. As reported by the Centers for Disease Control and Prevention (CDC), approximately $50 billion is spent annually for non-fatal and $754 – for fatal falls in adults who are aged 65 and over (Haddad, Bergen, & Florence, 2019). The evidence shows that falls are regarded as a preventable threat, and nurse training is one of the strategies to reduce this problem. This paper aims to discuss the project for staff training on falls in older adult patients, focusing on the financial aspect and including budget and revenue issues.

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Section One: Project Design Foundation

The XYZ Hospital that is chosen for this practicum change project provides care services to elderly patients with the aim of improving their lives, assisting with chronic illnesses, and educating them to practice self-care. The mission of this organization is to raise the awareness of risk factors and advance disease prevention to decrease the incidence of falls, chronic conditions, and other avoidable complications. The vision is formulated as follows: older adult patients will face fewer injuries and comorbidities, while having a more independent life.

The hospital’s philosophy is based on the assumption that excellence, ethics, commitment, and the spirit of respect lead to the betterment of the society. The strategic planning is controlled by the Senior Director, who is responsible for identifying the key steps and building various links to achieve harmonious and high-quality care. The given hospital employs the health manager business model that implies the emphasis on enhancing the health of complex populations and offers integrated care services. The details of the financial issues related to this project are to be discussed with the hospital’s budget manager, Senior Director, and Advanced Practice Registered Nurse (APRN).

This project is consistent with the mission, vision, and philosophy of the identified hospital since both of them have the purpose of addressing the problem of patient falls, improve the overall well-being of the whole population, and promote more independence that is of great importance for older adults.


Terms related to the budget and revenue

There is a range of budgeting methods that are used in healthcare to understand potential costs and benefits. Incremental budgeting implies that the budget for a new year is prepared based that of the previous year with some changes. In turn, zero-based budgeting implies that the budget is to be composed from the scratch, when the activities and resources are classified according to their importance (Greene & Turner, 2014). The difference between fixed and variable methods is expressed in possible changes in output or activity levels or a lack thereof. Fixed budget is static, while variable budget includes the prediction of the worst and best scenarios, leaving a place for alterations.

The term of the operating budget is associated with the statement in the Budget Classification Code as an annual budget, containing reimbursable work and the estimates of the total resource value. Revenue budget is expected to anticipate an organization’s expenditures and profits, including capitation (payment arrangement for care providers), negotiated rates (agreed with care professionals in advance), and reimbursement (compensation for service) (Chaghari, Saffari, Ebadi, & Ameryoun, 2017). As for revenue projections, they estimate the amount of money that an organization can generate within a particular period.

Terms related to the expenses budget

Fixed costs present those that cannot be changed regardless of the number of patients or other factors. They may include salaries, equipment, facilities, and rent, while variable costs are the cost of supplies or hourly laborers. In healthcare, variable costs are dynamic and formed under the number of procedures, patients, supplies needed, and so on. Direct costs provide the opportunity to trace them to certain cost objectives that can be related to a product, service, customer, or activity. For example, direct materials, labor, manufacturing supplies, and piece-rate wages can be noted (Burns, Stevens, & Lee, 2016). Indirect costs include insurance, depreciation, additional remuneration, quality control expenditures, et cetera. These costs cannot be assigned to a cost analysis, which makes them apart of corporate overhead.

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With regard to the proposed practice change project, the direct costs will involve the cost of the defined intervention, namely, nurse training that will require labor costs and direct materials, such as equipment and evaluation tools. The educator remuneration and quality control measures will compose expected indirect costs. The revenues of the target organization are likely to increase as care for elderly patients will become more effective and cost-efficient.

The successful implementation of the intervention is likely to reduce the costs of the hospital for older adult care since the rate of falls and associated injuries will decrease. The direct savings will include less costs for identified patients (materials, procedures, and labor), and indirect savings will be fewer expenditures for addressing the adverse impact of falls on older adults (wheelchairs, supportive equipment, treatment of fractures, and mortality issues). The possible expenses are training materials, hospital unit staffing, and preceptor appreciation workshop.

Method of Strategies

The main stakeholders in the finance department are to be contacted to ask about meeting. The prospective strategic planning will be used to disseminate information about the proposed project goals, relevance, and financial impact. According to this strategy, the issue of reducing older adult falls is to be considered as the preparation for the future to anticipate patient needs (Guo, Tsai, Liao, Tu, & Huang, 2014). The planning should also contain personnel and resources needs in a long-term perspective, where nurse development is seen as a priority. Since the hospital’s philosophy, mission, and vision aim to ensure independence and overall well-being of elderly patients, they are consistent with the idea of fostering patient care and preventing falls as a result of the suggested intervention.

It should also be stressed that the prospective planning allows for flexibility in case of changes in resources and personnel. In particular, it is expected that the bulk of the nurses working currently in healthcare will be replaced by new specialists within a decade (Enderlin et al., 2015). In this connection, it is critical to promote their awareness of falls so that they can also disseminate this valuable knowledge to their colleagues and share practical reflections. The practice change seems to help the hospital in improving customer service and decreasing recurring clients as they will face fewer health complications. The liability risks may also be decreased based on the clarification of care scope and the standardization of communication between nurses and patients.

In Summary

To conclude, the benefits that will result from the implementation of the nurse training project are likely to overlap its costs. It is found that direct and indirect costs discussed in this paper include training materials, remuneration, and staffing, but the hospital will save on equipment, additional care services, and extra labor needs. The prospective planning strategy is selected to introduce the identified practice change project to the hospital financial department.


Burns, E. R., Stevens, J. A., & Lee, R. (2016). The direct costs of fatal and non-fatal falls among older adults — United States. Journal of Safety Research, 58, 99-103.

Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A. (2017). Empowering education: A new model for in-service training of nursing staff. Journal of Advances in Medical Education & Professionalism, 5(1), 26-32.

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Enderlin, C., Rooker, J., Ball, S., Hippensteel, D., Alderman, J., Fisher, S. J.,… Jordan, K. (2015). Summary of factors contributing to falls in older adults and nursing implications. Geriatric Nursing, 36(5), 397-406.

Greene, M. A., & Turner, J. (2014). The financial impact of a clinical academic practice partnership. Nursing Economics, 32(1), 45-48.

Guo, J. L., Tsai, Y. Y., Liao, J. Y., Tu, H. M., & Huang, C. M. (2014). Interventions to reduce the number of falls among older adults with/without cognitive impairment: An exploratory meta‐analysis. International Journal of Geriatric Psychiatry, 29(7), 661-669.

Haddad, Y. K., Bergen, G., & Florence, C. (2019). Estimating the economic burden related to older adult falls by state. Journal of Public Health Management and Practice, 25(2), 17-24.

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