Simple low-cost changes can make a big difference in the overall cost of care is what New Hanover Regional Medical Center in Wilmington, North Carolina, recently found when it crunched the number on its Lean management effort in fall prevention. However, it also found that most of those savings went to the government, insurers and patients, and not the hospital.

Writing about the effort, New Hanover President and CEO Jack Barto noted that the current system in which most of the savings from care improvement initiatives go to “whomever pays the hospital bill” is one of the reasons some healthcare reform changes will aid hospitals such as his. “As we transition to an ‘accountable care’ payment system, in which we are paid based on how healthy we keep patients and how well we control costs, the hospital provider and patient will both benefit,” he wrote on the hospital blog.

Using the principles of Lean, New Hanover developed a series of simple changes and standard practices for patients at high risk of falls that dropped their already low rate of such events another 22 percent and achieved an estimated more than $500,000 in savings at its hospital. Steps included:

1. Creating a care standard where the nursing team does hourly checks on high fall risk patients in order to anticipate patient needs to get out of bed, such as going to the bathroom, the source of 54% of patient falls.
2. Strategically administering medications, so that patients are more likely to sleep through the night and less likely to wake up and try to get out of bed on their own.
3. Identifying patients at high risk of falling with yellow socks, which reminds both patient and the care team of the risk.
4. Placing signs in the patient’s room that identifies the risks and how caregivers should respond.
5. Educating patients about fall prevention, and involving them in the effort by having them sign a “fall prevention partnership” agreement with the nursing staff.
6. Making sure a walker is placed in every room.
7. Posting how many days they have gone without a fall in clinical units and holding celebrations after every 30 days without a fall.
8. Having a “fall huddle” with the care team when a fall does occur to discuss what happened and how it can be prevented going forward.