Relationship between information technology functionalities and hospital-acquired injurious fall rates in US acute care hospitals

Huey-Ming Tzeng,Chang-Yi Yin,Yu Kang,Hsou Mei Hu

doi:10.4236/ojn.2012.22016

Abstract

The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.

Highlights

Hospital-acquired fall-related injuries are still a widespread concern and a challenging patient safety issue in hospitals settings
This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented information technology (IT) functionalities in their general medical and surgical inpatient units
Inspired by the reports by the National Quality Forum (NQF) and Stead and Herbert [10], we propose in this current study that fully implemented health IT functionalities in general medical and surgical inpatient units can be used as measurable structure measures

Summary

Introduction

Hospital-acquired fall-related injuries are still a widespread concern and a challenging patient safety issue in hospitals settings. The systematic review study conducted by Oliver and associates [1] concluded that the most appropriate approach to fall prevention in the hospital environment was multifactorial interventions with multiprofessional input This far, limited evidence was available to support the effectiveness of single interventions (e.g., delirium avoidance programs, reducing sedative and hypnotic medication, and patient education). The recent U.S health care bill, the 2010 Patient Protection and Affordable Care Act, imposed an 1% penalty on Medicare payments to hospitals in the top quartile of HAC rates that will begin in 2015 [9] Because of these financial pressures, hospitals are searching for effective practices to prevent hospital-acquired injurious falls

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Conclusion