Christiana Care Health System (CCHS), headquartered in Wilmington, Delaware, is a not-for-profit health system and a teaching hospital with two campuses. CCHS includes two hospitals with more than 1,100 patient beds, a home health care service, preventive medicine, rehabilitation services, a network of primary care physicians and an extensive range of outpatient services.
CCHS partnered with ECRI Institute Patient Safety Organization (PSO) to use resources provided by ECRI Institute PSO combined with their nursing department’s Lean Six Sigma process and Value Institute, their research center, to analyze and reduce patient falls.
In 2012, ECRI Institute PSO utilized our assessment tool, INsight® Fall Prevention, to identify and provide a baseline assessment for CCHS’s falls rate. The average patient falls rate for CCHS’s three medical patient care units was 4.8 which was above the National
Database of Nursing Quality Indicators mean benchmark of 3.4 for magnet facilities for patient falls. Annually, between 700,000 and 1,000,000 people in the United States experience falls while in the hospital. The rate is alarming, especially because falls are easily preventable (close to one-third can be prevented) when appropriate and effective measures are implemented.
Based on recommendations from ECRI Institute PSO, CCHS implemented the Lean Six Sigma process by forming an interdisciplinary team selecting front line staff who understood process and practice variation, calculated the business case or cost of poor quality, and evaluated their processes. The team analyzed trends, identified root causes, and developed targeted action plans:
- Set target goal at 30% falls reduction
- Evaluate accountability and effectiveness
The team studied matched units so that they could compare results to evaluate the effectiveness of leadership engagement and unit champion/front line staff involvement on accountability.
The research found that early (beginning with program design) and active leadership and front line staff involvement significantly reduced the falls rate. Staff accountability for falls prevention was achieved through the establishment of a control plan to monitor ongoing compliance throughout the continuum of care, including actively engaging patients in falls prevention through handoff communication, mobility assessment, and purposeful hourly rounding.
In November of 2015, Susan Mascioli, director of nursing quality and safety, shared the successes with ECRI Institute PSO member providers and showed how the INsight Falls Prevention tool was used to obtain a baseline gap analysis for the CCHS falls prevention program. The assessment provided evidence-based recommendations and system- and facility-level results in color-coded dashboard reports, compared to other PSO member providers who have implemented the Lean Six Sigma strategies and compared to all others in the ECRI Institute database.
The remarkable result from the CCHS initiatives has led to:
- A 52% reduction in the combined falls rate on the three pilot units, far exceeding their goal of a 30% reduction.
- A reduction in the overall falls rate from 4.8 in 2012 to 1.80 in 2015 across three patient care units.
- A reduction in the annual cost of falls by $20,000.
- Statistically significant differences in success of strategies between units involved in the Lean Six Sigma strategies and those units not involved.
"By using the tools provided by our PSO, we were able to target opportunities for improvement, identify and remove barriers," said Mascioli.
Learn more about ECRI Institute PSO membership.