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Environmental Factors That Contribute to Falls

Posted By Administration, Wednesday, August 5, 2015
Updated: Wednesday, August 5, 2015
An interview with Debajyoti Pati, PhD, recipient of an NPSF Research Grant for a study of extrinsic factors associated with fall risk, specifically design elements of hospital rooms and bathrooms.

According to a 2013 publication from the Agency for Healthcare Research and Quality, falls are the most frequently reported incident in adult inpatient hospital units, and 30% to 51% of falls result in some injury. Prior research into contributing factors has largely focused on intrinsic factors, such as patient-specific conditions, age, use of medications, and the presence of visual or other impairment.


Recent research funded in part by the NPSF Research Grants Program focused on one class of extrinsic factor—the physical design of the hospital room and bathroom. With help from Covenant Hospital (Lubbock, Texas) and HKS Architects, the researchers created mock physical space in a state-of-the-science lab at Texas Tech University and enlisted human subjects to test “worst-case scenarios” for potential falls.


Results of this study were recently presented at a meeting of the American Society of Mechanical Engineers. ASME honored the researchers with an award in recognition of the study’s innovative methods.


In this post, the study’s principal investigator, Debajyoti Pati, PhD, FIIA, IDEC, LEED®AP, answers some questions about the work. Dr. Pati is professor and Rockwell Endowment Chair, Department of Design, College of Human Sciences, Texas Tech University.


Q: What was the biggest challenge you faced in this study?

A: One of the biggest challenges was developing a bathroom configuration that would represent a typical inpatient bathroom. This involved surveying the design archives of HKS Architects, who have more than 70 years of experience in designing hospitals. Another challenge was developing a script that represents most scenarios of patient falls across all hospitals. This task was taken up by the Falls Committee of Covenant Hospital in Lubbock. The committee surveyed the industry to come up with representative scenarios.


Q: One part of your study identified the typical patient profile and fall details for worst case scenarios. Can you talk about this a bit?
A: The Covenant Hospital Falls Committee surveyed information from across the industry and their own experience to develop scenarios that represent all hospitals. These individual scenarios were subsequently collated by the investigators to generate a single script that includes the worst case scenarios, while not demanding too much time from the subjects. The final script was reviewed by the Covenant Falls Committee. We conducted several pilot runs in the presence of the Falls Committee members to ensure that the setting and the scenarios are realistic and representative.


Q: What can you tell us about your findings?
A: We are in the process of submitting manuscripts to two journals, but I can say that falls occur owing to intrinsic and extrinsic factors. We focused on one class of extrinsic factor (the physical design). During day-to-day activities people are forced to interact with elements of the physical environment. When they do, it involves several types of postural changes. Three postures were significantly correlated with falls – turning, pushing and pulling (not in any order). In the report, we have identified the specific physical elements in a patient room and bathroom that when combined with these postures result in potential falls. We have also made design recommendations to reduce fall events. We have a separate section in the report discussing the implications of the findings for patient room design.


Q: Does this research point to any immediate steps that hospitals or patients and families could take to reduce the risk of falls?
A: The best way to avoid falls is for patients to never venture to the bathroom alone. That needs operational and/or policy interventions. But patients do make trips to the bathroom alone – and in those situations, the physical design can be used to reduce the chances of a fall event. Our findings include those that involve room/bathroom configuration (very difficult – almost impossible - to change once a hospital is built), and those that involve individual elements (door, toilet bowl, IV pole, number and location of grab bars, etc.). None of these can be considered as minor fixes, although renovation is possible. With the right configuration at and around the toilet bowl, changing the grab bars is one minor fix I can think of. Hospitals can also take proactive measures in removing any obstacles around the bed and on the path to the bathroom. Physical objects that patients unnecessarily need to push or pull or navigate around are an important source of potential falls.


For patients, I’d advise never go to the bathroom alone. For families – if family accommodation is available in the patient room, stay close to the patient at all times and help. Some hospitals have increased the frequency of nurse rounding as an operational intervention to reduce unaided patient trips to the bathroom, and have shown considerable success.

Q: Although the study focused on a very specific setting and hospital room configuration, is it possible that that these findings have implications for reducing falls in other settings, such as for patients receiving care in their homes?
A: Yes. Many of the human–environment interactions identified in this study are also those one encounters at home or other long-term care settings.

Q: What surprised you the most, either about the way the study progressed or your final results?
A: I think we were most surprised by the role of the IV pole in potential falls. I had never thought about it before.

Q: What’s next for this area of research?
A: The design recommendations made in this study (implications for design practice) are essentially design hypotheses. The next step is to test those out through further studies to develop design guidelines.

Q: What can you tell us about the award your paper received from ASME?
A: The ASME award pertains specifically to the methodology of the study – a novel way of using motion-capture technology to detect potential falls. We are so glad that we had such innovative mechanical engineers in our team.


What aspects of your hospital's environment can be changed to reduce falls? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.


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