AUTHOR BIOGRAPHIES
Patricia Macolino, MSN, RN, Quality Ambulatory Care for the Clinical Practices of the University of Pennsylvania, Penn Medicine
Quality Ambulatory Care for the Clinical Practices of the University of Pennsylvania, Penn Medicine
Patricia Macolino (patricia.macolino@pennmedicine.upenn.edu) is the director of Quality Ambulatory Care for the Clinical Practices of the University of Pennsylvania (CPUP), Penn Medicine. She is a registered nurse and a certified Lean Six Sigma Green Belt, and she earned her Master of Science in nursing at Walden University. Additionally, she is a Certified Professional in Healthcare Quality and acts as an instructor for courses within the Center for Healthcare Improvement and Patient Safety.
*Corresponding author
Katie Fox, MBA, Clinical Practices of the University of Pennsylvania, Penn Medicine
Katie Fox is a master improvement advisor at the Clinical Practices of the University of Pennsylvania (CPUP), Penn Medicine. She earned her Master of Business Administration from Temple University and Lean Six Sigma Black Belt certification from Villanova University.
Rebecca Fitzpatrick, DNP, MSN, MPH, Penn Medicine
Rebecca Fitzpatrick is a regulatory affairs consultant at Penn Medicine. Previously, she was a clinical director at the Clinical Practices of the University of Pennsylvania (CPUP). She earned her Master of Science in public health and education at the University of Pennsylvania, Master of Science in nursing at Georgetown University, and doctorate in nursing at Jefferson
Vivek N. Ahya, MD, MBA, University of Pennsylvania Health System
Vivek N. Ahya is the chief medical officer for the Clinical Practices of the University of Pennsylvania (CPUP), Penn Medicine. Dr. Ahya is an associate professor of Medicine (Pulmonary, Allergy and Critical Care) at the Hospital of the University of Pennsylvania (HUP). He was trained at the Boston University School of Medicine and received his Master of Business Administration from the Johns Hopkins Carey Business School.
Ilona Lorincz, MD, MSHP, University of Pennsylvania Health System
Ilona Lorincz is the patient safety officer for the Clinical Practices of the University of Pennsylvania (CPUP), the director of quality for Endocrinology, Diabetes, and Metabolism at the Hospital of the University of Pennsylvania (HUP), and an associate professor of Clinical Medicine of the Perelman School of Medicine. Dr. Lorincz was trained at the Georgetown University School of Medicine and received her master’s in health policy research from the University of Pennsylvania.
Barbara Prior, RN, MSN, University of Pennsylvania Health System
Barbara Prior is the associate executive director of the Clinical Practices of the University of Pennsylvania (CPUP). She received her Bachelor of Science from The College of New Jersey and her Master of Science in health leadership from the University of Pennsylvania. Prior is board certified as a nurse executive by the American Nurses Credentialing Center (ANCC). She is an active member of American Organization of Nurse Leaders (AONL), American Academy of Ambulatory Care Nursing (AAACN), and the American Nurses Association (ANA).
Abstract
Introduction
Patient falls in ambulatory settings are uniquely challenging in that patients have more autonomy during outpatient visits and are not always easily identified as at risk for falling. Falls result in patient harm and dissatisfaction, loss of revenue, and a potential impact to the reputation of the health system.
Objectives
The primary objective of this study was to describe the work done to reduce falls risk for ambulatory patients.
Methods
This was a quality improvement project that used traditional improvement methodology to perform root cause analysis and process mapping, and to test and implement change strategies.
Results
The falls rate for ambulatory patients fell from 0.050 in fiscal year (FY) 2022 to 0.039 in FY23, a 22% reduction. The falls rate for ambulatory patients has continued to decrease; the current annual falls rate for FY24 is 0.030, a 37% reduction from FY21 rate 0.051, when a sentinel fall prompted root cause analysis and team focus.
Conclusion
While the initial intervention was only moderately successful, it led to a renewed focus on the risk of patient falls, which resulted in additional interventions and ultimately a reduction in high harm falls and the annual falls rate.
Publisher’s Note
This article was corrected on January 6, 2025, to reflect the authorship of Vivek N. Ahya, Ilona Lorincz, and Barbara Prior for their significant contributions to the manuscript, including their accompanying affiliations and author bios. The author bio for Rebecca Fitzpatrick and the Acknowledgments were also slightly revised.
Fall prevention is a patient safety focus in many healthcare settings; however, as the first step usually involves screening to determine a patient’s fall risk, it is more difficult to identify patients at risk for a fall in an ambulatory clinic before they have been screened. After noting an increase in patient falls in its ambulatory practices in 2021—including one which resulted in patient harm—the University of Pennsylvania Health System (UPHS) set to work on reducing falls risk for ambulatory patients.
The quality improvement project was piloted at an outpatient Neurology clinic that averages 6,500 patient visits each month, focused on redesigning the falls screening process and actions to take when a patient screens positive, with the goal of reducing falls by 10% from July 2021 to December 2023. Changing wellness survey screening questions to receive better information from patients and better identify their risk to avoid falls ultimately resulted in a 22% reduction in falls rate, which has continued to decrease beyond the original study period, as well as a reduction in the severity of injuries from falls.
