One of the most dangerous activities for hospital patientsis the seemingly simple act of getting out of bed.
Forthe weak and woozy headed, it can lead to a hard fall, serious injuriesand several thousands of dollars in added medical bills.
Now anew University of Florida study casts doubt on one of hospitals' primaryfall-prevention measures, bed alarms, which were designed to alertmedical staff when patients are getting up when they're not supposed to.
Thestudy highlights a persistent problem for hospitals and the leadingcause of injury and death for adults older than 65. U.S. emergencydepartments treat more than 2 million such injuries a year, according tothe Centers for Disease Control and Prevention, at a cost of about $30billion.
An 18-month review of nearly 28,000 patients, using 349beds, at Tennessee Methodist Healthcare University Hospital found thatthe alarms did not translate into fewer falls.
This happened despite medical staff training in their use and hospital promotion of them, according to the study.
Toooften, the devices sounded off improperly, leading to "alarm fatigue,"said Dr. Ronald Shorr, the study's principal investigator and aprofessor of epidemiology at the University of Florida.
Thetakeaway: Alarms do little by themselves, he said. They can be ignored. Abetter approach, he said, is to train staff to closely monitor at-riskpatients and remind patients and their families about the risks.
"There's no magic recipe to make these things go away," Shorr said. "There's not a technological fix."
Rather, hospitals need to employ a variety of methods such as closepatient observation and awareness of those most at-risk, Shorr said.
Thebed alarms used in the study cost about $400 apiece and are little morethan plastic-covered pads placed under patients. Lee Memorial HealthSystem in Fort Myers, Fla., used them until about a year ago, when itswitched to alarms built into hospital bed mattresses.
TheLee Memorial Health System ranks all its patients according to theirfall risks. Those particularly in danger have signs posted outside theirrooms, which may be those closest to nursing stations.
The newalarms imbedded in patient bed mattresses send out a piercing sound whenpatients move to get up. Janet Fulton, director of inpatient oncologyat Lee, considers them much more reliable.
Their patient tags willalso carry special, yellow tabs that identify them as fall risks.Patients are told to ask for help when they want to get up - advice theysometimes ignore - and family members are urged to not let them walkunattended.
Among them is Dan Shortt, 54, of LaBelle, a recentpatient at Lee Memorial Hospital. Shortt, who has liver cancer, saidfainting spells are common. So far, he's only suffered some nasty cutsand bruises.
His bed alarm was kept off, but Shortt said he's well aware of his tendency to fall.
"It's not about being weak," said Shortt from his hospital bed last week. "It just comes on real quick.
Studiesshow that falls are most likely to happen between 7 p.m. and 7 a.m. andare commonly the result of patients getting up to use the bathroom.
"Apatient who is elderly, they may be forgetful, they may be confused,"Fulton said. "And even if you give them instructions they may notremember that."
Tough to prevent
While hospitalinfections and medical errors get much of the attention when it comes tohealth center mishaps, falls remain one of the most frustratinglydifficult to prevent.
According to the Centers for Medicare andMedicaid Services, the national average for falls and injuries is 0.527per 1,000 patient discharges.
The Medicare data can vary wildlyand does not account for different kinds of patients that each of thesehospital systems are treating. In other words, higher rates may alsomean the hospitals are seeing sicker patients, according to CMS.
Whateverthe number, about 2 percent of all falls at hospitals result in longerstays, studies show. The average added treatment cost is about $4,000.
"Thisis one of the most common adverse events," Shorr said. "If the problemwas easily solved we would have figured it out a long time ago."
The cost of falling
Accidentalfalls are the leading cause of injury and death in adults over the ageof 65, according to the Centers for Disease Control and Prevention. Thisis a problem even in U.S. hospitals, which employ various means ofmaking sure at-risk patients stay safe. Still, falls happen, and theycome with a cost.
• 2.3 million: Number of nonfatal fall injuries among older adults that were treated in ER.
• 662,000: Number of those ER patients were hospitalized.
• 25 percent: Percentage of hospital falls that result in injuries.
• 2 percent: Percentage of hospital falls that result in medical complications.
• $4,000: Average dollar amount added to medical bills as a result of inpatient falls.
Sources: U.S. Centers for Disease Control and Prevention, the University of Florida Academic Health Center