An Analysis of Falls and Those who Fall in a Chronic Care Facility.

OBJECTIVES: Falls in hospitals lead to adverse patient outcomes and prevention of falls is of upmost importance. Little is known about fall and injury rates in chronic care facilities, which are similar to skilled nursing facilities in the United States. Current fall risk tools in this setting are not well studied. Enhancing the understanding of how patient characteristics relate to fall circumstances is also needed. DESIGN: Retrospective analysis of falls over 3 years on consecutive admissions and discharges. SETTING AND PARTICIPANTS: A 104-bed geriatric chronic care facility. MEASURES: Fall and injury data, descriptive data for patients measuring mobility, balance, cognition, function, and frailty in relation to risk of falls and fall circumstances were analyzed. RESULTS: There were 1141 falls, with an overall fall rate of 8.48 falls per 1000 occupied bed days. The overall injury rate was 37.2 injuries per 100 falls. Being male and frail, having a mobility aid, poor mobility, balance, or cognition were associated with falling. Patients with good balance but poor cognition was more likely to fall outside their room, while those with poor mobility/balance fell more often in their room. The Clinical Frailty Scale performed modestly well at predicting falls with an odds ratio of 2.5 (95% confidence interval 1.9-3.2). CONCLUSIONS AND IMPLICATIONS: Fall rates in chronic care facilities differ from what is reported in other settings. Patient characteristics such as male, use or misuse of a mobility aid, and poor cognition are more common in fallers. Fall circumstances differ in those with poor cognition compared with those with poor mobility and balance. More research focusing on frailty, cognition, and mobility/balance is needed to develop accurate tools that can predict those at a high risk of falls in these facilities.

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.

PURPOSE: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. METHODS AND MATERIALS: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. RESULTS: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P<.0001). With a >16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of "$[(anesthesia cost to payer during radiation therapy course/6) - (CCLS expense to payer/N)]" per child (N) treated with radiation therapy, where N equals the number of children aged 3 to 12 years treated in 1 year. This formula assumes that the payer subsidizes the cost for the employment of a CCLS, although our institution absorbed this expense for this data cohort. The predicted annualized health care system cost savings from reducing the frequency of anesthesia with radiation therapy when treating 100 children aged 3 to 12 years per year could exceed $775,000. CONCLUSIONS: These data suggest that a CCLS significantly reduces the frequency of daily anesthesia for children treated with radiation therapy. Health care system payers may achieve significant cost savings by financially supporting the employment of a CCLS in high-volume pediatric radiation therapy centers.