Identifying and Examining Micro Physical Environment Factors Contributing to Patient Falls (Texas Tech University Project)
Debajyoti Pati (PI), Jaehoon Lee, Shabboo Valipoor, and Aimee Cloutier, Texas Tech University
Tom Harvey, Principal and Senior Vice President, President of CADRE, HKS Inc., Dallas, TX
National Patient Safety Foundation Research Grant
WHAT WAS THE AIM
The study objective was to identify and examine physical design elements and attributes that contribute to potential fall events in the patient bathroom and the clinician zone.
Why is it important
Patient slips and falls are common occurrences in hospital bedrooms and bathrooms, particularly among elderly patients. It constitutes one of the most serious adverse reported patient safety events. Falls in hospitalized patients are complex events associated with multiple intrinsic and extrinsic risk factors. While a large body of information exists on intrinsic factors, literature on extrinsic factors are relatively very few. Since falls are rarely observed in real time, little is known regarding interventions in physical design that may reduce falls.
WHAT DID WE DO | HOW DID WE DO IT
Thirty subjects over 70 years of age (11 males and 16 females) conducted scripted task in a mockup of a bathroom and the clinician zone of a patient room. All activities were captured using motion capture technology and conventional digital video capture. Data processing involved marker labeling in Cortex, COM tracking in Visual3D, and jerk calculation/potential fall identification in MATLAB. Video clips associated with potential fall moments identified in MATLAB were extracted from the digital videos. The potential fall videos were examined and coded by a group of registered nurses and healthcare designer/planners. Exploratory analyses of the coded data were conducted followed by a series of multivariate analyses using regression models.
What did we find
Age, sex and bathroom location (left or right side of the bed) emerged as significant variables predicting potential falls inside the bathroom. However, their significance was lost when posture variables were added to the model. In the clinician zone, only the posture variables demonstrated statistical significance. Inside the clinician zone, the significance postures were pushing and pulling, in that order. The significant bathroom postures included turning, grabbing, pulling and pushing, in that order.
What is next
This study raises several critical questions for future studies - some from a theoretical/ academic perspective, but a large number from design innovation (applied) studies. Does the right side location of bathroom truly reduces falls, or was the influence identified in this study a spurious one? Does it hold true for footwall location? The more important questions relate to postures resulting from physical design. What are the characteristics of a bathroom that could reduce turning, grabbing, pushing and pulling? Would a sliding door help reduce the rate falls? What is the association between the angle of turn and fall? Is there a threshold in turning angle beyond which turning significantly increases probability of fall? Would a wider door opening deliver lower falls? Can the IV pole be redesigned? Can a toilet designed with folding grab bars with space for caregiver, higher seat, permanently lowered seat, and flush handle/button operable in standing position reduce falls? Can the need for patients to shuffle sideways be reduced or eliminated? What are some of the physical design and configuration options that can be generated and used in practice? What configuration of the patient room will enable leaving the bathroom door open when the bathroom is being used, while maintaining privacy?