By Greg Freeman
EXECUTIVE SUMMARY
The cost of a patient fall can extend far beyond the immediate care expenses. Legal costs and unreimbursed treatment must be factored into the total.
- Knowing the true overall costs of a fall can be useful in justifying risk reduction methods.
- Falls make up a large proportion of healthcare claims.
- Falls in the hospital tend to be more serious than falls outside the facility.
Falls in a healthcare facility can have serious health consequences for the patient. This is reason enough to aggressively pursue a risk reduction program. However, the financial cost to the healthcare provider cannot be ignored, and those losses can be helpful in justifying the time, effort, and money spent on fall reduction.
Falls make up a large proportion of all claims in healthcare, with the cost to the hospital averaging $7,000 to $30,000 per fall, says Bette McNee, RN, NHA, clinical risk management consultant at insurance broker Graham Company in Philadelphia. That may include the costs of an unreimbursed, extended hospital stay.
In addition, there is the legal expense incurred with fall claims. McNee offers this summary of research showing the cost of falls in healthcare:
- Slips, trips, and falls make up 66% of all claims in healthcare.1
- Each year, 700,000 to 1 million patients fall in U.S. hospitals.2
- Of those patients who fall, 30%-35% will sustain an injury. On average, each injury adds more than six days to a patient’s hospital stay. That leads to an average cost of a fall with injury to more than $14,000 per patient.3
- The unreimbursed costs for treating a hospital-related fall injury range from $7,000 to $30,000, depending on the severity of the injury. In addition, these events cost hospitals an average of $55,000 in legal claims and proceedings.4
- Falls cost the health system about $50 billion annually.5
- Injurious falls are associated with increased hospital stays of six to 12 days. The costs of serious episodes of injury range from $19,376 to $32,215.6
- Death or serious injury resulting from a fall in a healthcare facility is considered a never event. CMS does not reimburse hospitals for additional costs associated with patient falls.7
Hospital Falls Usually More Serious
Hospitalized patients are at an increased risk for falls, which may result in serious injuries, such as hip fractures, subdural hematomas, or even death.
“This is typically a more frail client, a postsurgical patient, or someone who is medically frail,” McNee explains. “When they suffer a fall, it tends to be of higher severity than someone who falls at home. These folks are already compromised, so the potential for fractures, subdural hematomas, and even death are higher than you will find from a common fall outside the hospital.”
The costs of such falls are so significant, especially when looking at the whole picture and not just the immediate expenses, that they should be addressed when seeking administration approval or support for any fall reduction efforts.
“Using data to quantify the cost of claims on both frequency and severity is very important,” McNee says. “Costs develop over time, so it is important that you don’t just look at the cost of care because then you’re not considering all the legal pieces that get added in. Another factor that is not easy to quantify is how responding to a lot of these claims can affect the risk rating of a hospital, and naturally, the expense of insurance.”
The cost of a fall should be considered in the post-fall analysis. When the clinical team determines a fall was preventable, and redesigns a process or system, that is an opportunity to capture the return on investment.
“Not every fall prevention strategy is going to be expensive. Some of the most effective strategies involve staff education and awareness — improvements that don’t usually cost a great deal of money,” McNee says. “But when you do need to implement some improvement that might have a significant cost in terms of added expense, or even a loss of revenue, it can be useful to know how much you’re going to save in terms of avoiding those preventable falls.”
Some effective tactics for preventing falls include contracts with patients and families about complying with care protocols, including avoiding fall risks by asking for assistance when needed, McNee says. Another good approach is to identify how many falls occur during shift huddles and implement a process for rounding before these huddles. Nurses can be off the floor up to two hours for the huddle and handoff processes, during which falls can occur because no one is around to help the patient to the bathroom or for other needs.
For high-risk situations, technological solutions like cameras and bed monitors can be useful, but those often come with a high price tag. That is when knowing the costs of a fall can be especially useful in justifying the expense.
“Hospitals have done a good job of improving safety mindfulness regarding falls, but right now, healthcare is in a bit of crunch and there are so many things on front burners for frontline staff and administrators. But people have gotten very creative about implementing some of the best-practice strategies,” McNee says. “I don’t think hospitals have fully embraced some of the fall prevention technology, mostly because it’s new and rather expensive, but understanding the real cost of falls might help us get over that hurdle.”
REFERENCES
- The Hartford Staff. Slip, trip, and fall prevention for healthcare workers. The Hartford. Jan. 7, 2022.
- Agency for Healthcare Research and Quality. Preventing falls in hospitals. Page last reviewed March 2021.
- Joint Commission Center for Transforming Healthcare. Preventing falls. 2022.
- Bock TJ. A solution to sitters that won't fall short. Nurs Manage 2017;48:38-44
- Florence CS, Bergen G, Atherly A, et al. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc 2018;66:693-698.
- Dykes PC, Burns Z, Adelman J, et al. Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: A nonrandomized controlled trial. JAMA Netw Open 2020;3:e2025889.
- PSNet. Falls. Sept. 7, 2019.
SOURCE
- Bette McNee, RN, NHA, Clinical Risk Management Consultant, Graham Company, Philadelphia. Email: [email protected].
Falls in a healthcare facility can have serious health consequences for the patient. This is reason enough to aggressively pursue a risk reduction program. However, the financial cost to the healthcare provider cannot be ignored, and those losses can be helpful in justifying the time, effort, and money spent on fall reduction.
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