Linkages between the safety of the hospital bed, patient falls and immobility

描述（申请人提供）：医院和养老院的跌倒干预项目表现不佳，仍然有许多患者和居民在医院摔倒受伤。病人所处环境的一个方面尚未被系统地评估为诱发跌倒的因素，那就是医院的病床。在我们的试点研究中，床的高度，侧轨的不稳定性，以及在离开床时缺乏把手都导致了跌倒的风险。在本研究中，我们将研究床的高度、侧轨的配置、患者的身体特征和患者爬进下床时施加的生物力学力之间的关系。64名来自急性和长期护理机构的参与者将在他们与病床互动时进行录像，这张床已经测量了患者的力量需求。生物力学、观察性和主观参与者数据将用于确定最佳病床高度和侧轨配置，以最大限度地减少跌倒风险和降低受伤风险。生物力学数据将包括进入、离开床和在床上重新定位时的关节扭矩，以及患者、地板表面和医院病床之间的物理相互作用。观察到的问题，如滑倒、平衡检查、不完整的入口/出口和接近坠落将被编码。参与者将提供主观评估他们对与不同床高和侧轨配置相关的跌倒风险的感知。我们还将研究用于床内移动的侧轨。本研究项目的最终目标是为医院病床设计建议，使患者能够安全地进入床上，以最小的努力重新定位自己，以最小的努力站在床边，并以最佳稳定的步态离开床。这个拟议的研究项目解决了AHRQ的患者安全使命，即研究重要的现有医疗保健技术（在本例中是医院病床）的相对有效性。安全病床的发展将保守地减少10%的床边跌倒，从而节省医疗保健系统的成本，估计到2020年，每年在预防伤害方面的成本为15亿美元。

DESCRIPTION (provided by applicant): Fall intervention programs in hospitals and nursing homes are performing poorly, and many patients and residents still fall in hospitals and injure themselves. One aspect of the patient's environment that has not been systematically evaluated as a trigger for falls, is the hospital bed. In our pilot research, bed height, instability of the side rails, and the lack of a handhold for use when exiting the bed all contributed to fall risk. In this proposed study we will examine the relationships between bed height, the configuration of side rails, patient's physical characteristics and biomechanical forces that are exerted as the patient climbs in and out of bed. Sixty four participants, recruited from acute and long term care settings, will be videotaped as they interact with a bed that has been instrumented to measure patient strength requirements. Biomechanical, observational, and subjective participant data will be used to determine the optimal hospital bed height and side rail configurations to minimize the risk of falling and reduce the risk of injury. The biomechanical data will include joint torque during bed entry, exiting, and in-bed repositioning, as well as physical interactions between the patient, floor surface and hospital bed. Observed problems such as slips, balance checks, incomplete entry/exit, and near falls will be coded. Participants will provide a subjective assessment of their perception of fall risk associated with different bed heights and side rail configurations. We will also examine the side rail use for in-bed mobility. The ultimate goal of this research program is to develop design recommendations for a hospital bed that will enable the patient to enter the bed safely, to reposition themselves with minimal exertion, to stand with minimal effort at the bedside, and to move away from the bed with an optimally stable gait. This proposed research project addresses AHRQ's Patient Safety Mission to study the comparative effectiveness of important existing health care technologies, in this case the hospital bed. The development of a safe hospital bed will conservatively reduce bedside falls by 10%, thereby saving the healthcare system costs estimated at $1.5 billion per year in the prevention of injury by 2020. PUBLIC HEALTH RELEVANCE: Patient falls from the bed result in serious injuries. In this project we will explore the bed height and stability of the side rails as they contribute to the risk of falling. We will also examine patients' use of the side rail to assist with turning and moving about in the bed. The ultimate goal of this research program is to design a hospital bed that will assist the patient to enter the bed safely, to reposition themselves with minimal exertion, to stand with minimal effort at the bedside, and to move away from the bed with an optimally stable gait. The development of a safe hospital bed will conservatively reduce bedside falls by 10%, thereby saving the healthcare system future costs of $1.5 billion per year in the prevention of injury. This proposed research project addresses AHRQ's Patient Safety Mission to study the comparative effectiveness of important existing health care technologies, in this case the hospital bed.