Nursing Unit Design and Hospital Falls

患者跌倒是医院报告的最常见的不良事件1-5，每年大约有100万 美国医院发生跌倒事故，造成超过25万人受伤和11000人死亡。 由于住院时间、医疗保健费用和诉讼的增加，跌倒使医院付出了代价。截至2015年3月， 退伍军人事务部(VA)国家患者安全中心(NCPS)患者安全信息 系统，一个保密和非惩罚性的报告系统，显示摔倒是最频繁的报告 退伍军人健康管理局(VHA)的病人伤害类别。7 尽管众所周知，医院的物理环境导致了近40%的重症或 致命的医院坠落，8我们对住院单位之间的关系的认识存在重大差距 设计和降落率。少数检查过病房设计的研究是在一家医院进行的。 或少量住院单元，限制了普适性。9，10此外，还没有研究 专注于退伍军人医疗中心(VAMC)的单元设计和Fall。退伍军人事务部建筑和设施办公室 管理促进循证设计。11因此，本研究的首要目标是确定单位 影响住院患者的设计因素在VHA范围内。本研究涉及2014年退伍军人管理局的战略6.3 2014-2020年退伍军人战略计划13的卓越蓝图12和目标3.3，两者都强调 VA空间的设计。具体地说，《战略计划》规定，退伍军人事务部将继续努力进行资本规划，以 提供安全、可靠、现代化和可持续的基础设施…“我们的研究将直接告知退伍军人事务部 努力翻新或建造物理空间，以提高退伍军人的安全。 为了实现这一点，我们提出了一项混合方法研究，以探索单元设计与 病人跌倒在退伍军人事务部内外科(内外科)。我们将利用定性的方法来调查 工作人员和管理人员对导致患者跌倒的环境因素的看法(目标1)。我们会 在目标2中使用定量方法来确定跌落率高于或低于预期的内科/外科病房 并确定区分它们的空间和环境因素。 这项研究的具体目的是： 目标1：调查一线和管理层对老兵跌倒的看法和经验 对住院环境因素的影响。我们将在马尔科姆医院的12个医疗/外科病房进行走访。 盖恩斯维尔的兰德尔VAMC、莱克城的莱克城VAMC和詹姆斯·A·黑利退伍军人医院 坦帕与单位和设施人员一起确定每个地点与环境有关的跌倒风险因素。访谈 调查结果将直接指导环境评估调查的发展，该调查将作为 目标2的结果，以及有助于解释目标2的结果。 目标2：通过比较空间和环境因素，量化单元设计因素与坠落率之间的关系 降幅高于预期的单位与低于预期的单位的因素。我们将使用退伍军人医院住院病人的秋季数据 评估中心(IPEC)和来自其他数据源的患者数据，以识别医疗/外科护理单元 降落率高于预期(n=25)，低于预期(n=25)。一旦这些单位被识别出来， 我们将测量空间因素，分析单位平面图的计算机辅助设计(AUTOCAD)文件，以及 环境因素，基于《目标1.统计检验》编制的环境评估调查 然后执行，以确定那些区分高和低离群值的设计因素。

Patient falls are the most common adverse events reported in hospitals.1-5 Each year, roughly one million patient falls occur in United States (US) hospitals resulting in over 250,000 injuries and 11,000 deaths.6 Patient falls cost hospitals due to increased lengths of stay, health care expenditures, and litigation. As of March 2015, the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS) Patient Safety Information System, a confidential and non-punitive reporting system, showed that falls were the most frequently reported category of patient harm across the Veterans Health Administration (VHA).7 Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or fatal hospital falls,8 there are significant gaps in our knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital or a small number of inpatient units, limiting generalizability.9,10 Furthermore, there have been no studies focused on unit design and falls in VA medical centers (VAMCs). The VA's Office of Construction and Facilities Management promotes evidence-based design.11 Thus, the overarching goal of this study is to identify unit design factors contributing to inpatient falls within the VHA. This study addresses Strategy 6.3 of the 2014 VA Blueprint for Excellence12 and Objective 3.3 of the 2014-2020 VA Strategic Plan13 both of which emphasize design of VA space. Specifically, the Strategic Plan states that “VA will continue capital planning efforts to provide safe, secure, modern, and sustainable infrastructure…” Our research will directly inform the VA's efforts to renovate or build physical spaces that improve Veterans' safety. To accomplish this, we are proposing a mixed methods study to explore the relationship between unit design and patient falls in VA medical/surgical (med/surg) units. We will utilize a qualitative approach to investigate staff and management perceptions with environmental factors that contribute to patient falls (Aim 1). We will use quantitative approaches in Aim 2 to identify med/surg units with higher- or lower-than expected fall rates and identify spatial and environmental factors that distinguish them. The specific aims of this study are to: Aim 1: Investigate front-line and management perceptions of and experiences with Veteran falls as they pertain to inpatient environmental factors. We will conduct walk-through interviews in 12 med/surg units at the Malcom Randall VAMC in Gainesville, the Lake City VAMC in Lake City, and the James A. Haley Veterans' Hospital in Tampa with unit and facility personnel to identify environment-related fall risk factors at each site. Interview findings will directly inform the development of an Environmental Assessment Survey to be conducted as part of Aim 2, as well as, contribute to interpretation of Aim 2 results. Aim 2: Quantify associations between unit design factors and fall rates by comparing spatial and environmental factors of units with higher- versus lower- than expected fall rates. We will use fall data from the VA Inpatient Evaluation Center (IPEC) and patient data from additional data sources to identify med/surg nursing units with higher- than expected (n = 25), and lower- than expected (n = 25), fall rates. Once these units are identified, we will measure spatial factors, analyzing computer aided design (AutoCAD) files of unit floorplans, and environmental factors, based on the Environmental Assessment Survey developed in Aim 1. Statistical tests will then be performed to identify those design factors that distinguish high and low outliers.