Our project team has successfully reduced the number of falls at Milton Ulladulla Hospital in the Illawarra Shoalhaven Local Health District (ISLHD) through the implementation of a falls reduction bundle.
We needed to develop an effective way to reduce falls in the hospital’s general ward, which had consistently high falls rates and a significant level of serious harm from falls incidents. Our goal was to reduce the falls rate per 1000 bed days by 50% within 12 months from the project’s inception.
We used a mixed approach, including an observational assessment, focus groups and data collection, which led to the implementation of a falls reduction bundle.
The bundle included:
- an inpatient bed risk assessment
- facilitation of point of care nursing
- an adjustment to the ward way of working.
Addressing a significant increase in inpatient falls
The most frequent adverse event in hospitals is falls. Falls can result in serious harm to patients and significantly increase their hospital length of stay. If a patient falls while in hospital, their stay may be extended by weeks if not months, and places them at further risk of developing a hospital acquired complication.
Between 2021 and 2022, the general ward at Milton Ulladulla Hospital saw a significant increase in inpatient falls, with a number resulting in serious harm including fractures. General falls reduction strategies were being used at this time with minimal impact.
To understand the root causes of the issue, we conducted an observational study, where we identified a number of issues, one of which was maintaining close observation of high falls risk patients, especially in single isolation rooms.
Introducing smart hospital beds and bedside workstations
Through extensive consultation with staff, we implemented a falls reduction bundle that included the following strategies:
- Admission checklist: This assisted staff to ensure all risk screening is completed on arrival to the ward, and to identify individualised risk mitigation strategies.
- ‘Right patient, Right bed’ risk assessment: Staff assessed whether their patient was in the most appropriate bed for their condition and level of supervision. There was encouragement and empowerment of staff to speak up if their patient needed relocating to a bed with higher visibility or needed to swap their bed to an alarmed low bed (Ook-Snow bed). This empowered staff to take ownership of patient safety and mitigate falls risk.
- Bedside workstations: Each room was equipped with the equipment to facilitate point of care nursing (chair, computer on wheels and observation machines).
- Use of smart hospital beds: These innovative, alarmed low beds allow for patient monitoring where nurses may be unable to provide constant supervision (eg in a single or isolation room). The beds have 3 adjustable alert phases, notifying the nurse when a patient moves, sits up or stands, assisting with early prevention of a fall.
- Adjusting ways of working: We adjusted the ward staffing model to include a float nurse, team nursing and rotation of staff through high visibility rooms. This reduced shift fatigue, while enabling point of care and companion nursing.
Consistent reduction in falls and serious injury
Our project demonstrates a significant reduction in falls rates and improved staff ability to manage high falls risk. The interventions have improved workflow and ensured the use of risk mitigation strategies. Through the implementation of the falls bundle, we have demonstrated a consistent reduction in patient falls and serious injury over time; from 11.24 falls per 1000 bed days in July 2023 to 1.87 falls per 1000 bed days in August 2024.
During the 2023-24 financial year, each fall at Milton Ulladulla Hospital that resulted in a fracture or serious head injury cost approximately $38,991. There were 10 of these serious Harm Score 2 falls in that financial year, costing the hospital almost $400,000 in total.
We purchased 8 smart hospital beds and mattresses for $82,360, funded by the hospital auxiliaries. We also purchased 5 work chairs for nurses for a total of $1,560, funded by the hospital itself. Altogether, the equipment cost $83,920.
If the previous pattern of falls had continued into the 2024-2025 financial year, the predicted costs related to serious falls would have been a further $389,910. Because the falls‑prevention equipment was a one‑off purchase, the estimated net saving in the first 12 months was $305,990.
Across ISLHD, there were 89 Harm Score 2 falls between 2023-2024, collectively costing about $3.47m (at a cost of $38,991 per fall). If falls‑prevention equipment costing $83,920 per ward was installed across 23 inpatient wards, the total investment would be $1.93m. Based on costings from Milton Ulladulla Hospital, ISLHD could save an estimated $1.54m in the first 12 months.
While the first year requires a substantial one‑off investment in equipment (such as specialised beds, chairs, workstations, and monitoring machines), the district could achieve ongoing annual savings of up to $3.4 million in subsequent years.
