In the June 4, 2009 issue of the New England Journal of Medicine, Sharon Inouye and colleagues authored an editorial about the Medicare policy of nonpayment for falls and its potential for unintended consequences. They make the argument that there really is not a good evidence base for interventions that prevent falls or prevent injuries from falls. They do note that their own multimodality intervention for delirium prevention, the Hospital Elder Life Program or HELP (see our October 21, 2008 Patient Safety Tip of the Week “Preventing Delirium”) has also been successful in reducing falls, though that data has not been published.
Their major concern is that hospitals may inappropriately intervene by using restraints in an ill-advised attempt to reduce falls (use of restraints, in fact, increases the likelihood of injury from falls). That may have the unintended consequence of reducing patient mobility. They even point out that the new Medicare policy has spurred an industry manufacturing devices intended to circumvent guidelines against traditional restraints.
We share their concerns about such unintended consequences. However, the CMS policy has caused hospitals to renew their focus on fall prevention. Most of the interventions in the HELP program (such as scheduled toileting, avoidance of restraints, avoiding psychoactive medications in the elderly, etc.) just make common sense and should be encouraged even without a more definitive evidence base, particularly since the cost of such implementation is relatively inexpensive.
Inouye SK, Brown CJ, Tinetti ME. Medicare Nonpayment, Hospital Falls, and Unintended Consequences. NEJM 2009; 360:2390-2393