A study led by a Texas Tech University design professor found multiple ways hospitals could redesign patient rooms to reduce falling among elderly patients.
Debajyoti Pati, who teaches environmental design in the College of Human Sciences, was the principal investigator on a grant funded in part by the National Patient Safety Foundation (NPSF). He wanted to look at how interior design could make the environment safer for elderly people, so he explored techniques in nursing, sports science, engineering and architectural research for ideas on how to study patient falls without actually having patients fall.
The proposal sent to NPSF included a collaboration between James Yang, a professor of mechanical engineering at Texas Tech; Aimee Cloutier, Yang's research assistant; Shabboo Valipoor, Pati's research assistant; health care design firm HKS Architects in Dallas; and Covenant Health's falls committee.
“Millions of families and thousands of hospitals are affected each year by falls, both here in the United States and throughout the world,” Pati said. “Stakeholders across the board wanted to know how hospitals can be designed to reduce falls, but the answers were not available, barring a few areas such as flooring.”
An independent committee of experts chose Pati's research from among 87 submissions because of multiple criteria, such as innovation, creativity, potential impact on the patient safety field, relevance to the organization's patient safety priorities and its inclusion of other disciplines.
“A major factor in the selection of Dr. Pati's research for grant funding was the project's originality and use of innovative methods to provide new insight into a common and pervasive patient safety concern: patient falls in hospitals,” said Dr. Tejal K. Gandhi, president and CEO of NPSF. “Although numerous studies have examined the factors associated with patient falls and strategies for preventing them, few, if any, existing studies have used the type of approach employed in Dr. Pati's research.”
The first step was creating likely fall scenarios. The Covenant falls committee surveyed industry data and used their experiences working with patients to create several individual scenarios for falls, and the design team put these together in a worst-case-scenario script.
Working with HKS, Pati and his team created a space representing a typical hospital room and bathroom, then had people interact with this environment in the same way a hospital patient would. The participants were protected from actually falling, but motion capture technology recorded their movements as they started to fall and predicted how they would keep falling.
Cloutier, who is working on a doctorate in mechanical engineering, said motion capture records precise information about the body's movement. A series of infrared cameras capture light from small reflective markers placed on the body, which target the underlying joint locations. When at least three cameras record that marker, its position can be recorded.
In this study, the team used motion capture to gather information about the smoothness of the participants' movements while performing common tasks within the hospital bathroom and around the hospital bed. It was expected a potential fall would be preceded by unsmooth movement, allowing the team to identify physical design elements that might contribute to patient falls.
The group found these falls frequently happened as elderly people were going from the room to an attached bathroom and needed to maneuver around objects to get there. They were more likely to fall doing certain types of movement, such as pulling, pushing or turning. Many of the suggested solutions involved renovating hospital rooms and bathrooms or at least altering a number of elements in a room, including doors, the toilet bowl, IV pole and the location of grab bars.
However, hospitals may be able to remove non-fixed obstacles around the bed or on the path to the bathroom.
“Physical objects patients unnecessarily need to push or pull or navigate around is an important source of potential falls,” he said.
The IV pole, a common site in any hospital room, is a different story. It played a larger role than expected in falls. The best way around that, Pati said, is for elderly patients to simply not go to the bathroom alone. Many hospitals already are taking steps so nurses and assistants visit patients more frequently and can help patients move.
This research, no matter how broadly the findings are implemented, won't get rid of falls, Pati said, as the physical design of the room is only one factor that contributes to elderly people falling. However, it does point out a few ways, some simple, some that require renovation, hospitals, nursing homes and home health care providers can take to reduce the number of falls to which the environment contributes.
The next step, now that they've identified one of the problems, is to test the possible solutions this study suggested.
The paper received an award from the American Society for Mechanical Engineers for its methodology in including motion capture technology to solve the problem, and Cloutier was in Boston earlier this month to present the paper at the ASME International Design Engineering Technical Conference.