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We dive into the persistent challenge of fall prevention in hospitals with our guest, Christine Gall, a nurse executive. Despite advancements in patient safety, falls remain a significant issue, resulting in severe injuries and even death. We explore why traditional prevention strategies often fail, the staggering human and financial costs of falls, and how innovative solutions like virtual monitoring can make a difference. Christine shares her insights on data-driven approaches, the role of technology, and what health care leaders can do to create safer environments for patients, especially as the aging population grows.
Christine Gall is a nurse executive.
She discusses the KevinMD article, “Embracing data-driven solutions to prevent falls.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Christine Gall, a nurse executive. Today’s KevinMD article is titled “Embracing Data-Driven Solutions to Prevent Falls.” Christine, welcome to the show.
Christine Gall: Kevin, thanks so much for having me.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Christine Gall: Well, I started out as a pediatric nurse here in Southeast Wisconsin at Children’s Wisconsin. And, you know, very quickly I recognized that I wanted to do other things. My career is really based on the promise of curiosity. I’ve always wanted to learn more and try to impact the challenges of the day.
So, I’ve done everything from clinical work—I started out in pediatric cardiac care and step-down care—and have had the great opportunity to have leadership positions, develop programs from concept to implementation, and really enjoyed that whole inquiry process. I then pivoted into patient experience and spent about 10 years doing benchmarking for a national database for pediatric critical care.
Throughout my journey, I’ve always wanted to explore deeper where we could impact and influence the delivery of care differently to improve outcomes for patients.
Kevin Pho: Perfect. In today’s episode, we’re going to talk specifically about falls. Your KevinMD article is Embracing Data-Driven Solutions to Prevent Falls. Now, what led you to write this article in the first place? And then talk about the article itself for those who didn’t get a chance to read it.
Christine Gall: Yeah, well, I’ll tell you, we had a landmark book come out almost 25 years ago now called To Err Is Human, and we still haven’t solved patient safety. When you look at fall rates across the United States, you’ll see that the issue still persists. Although I started out in pediatrics, I am now laser-focused on what’s happening to our citizens at the end of life.
I have a front-row seat to my own parents as they age. And what I have seen—and the data and literature support this—is that falls often lead to that inevitable final decline in life. I think it’s something that we have to pay attention to. There are so many issues that we have to deal with in health care that challenge our ability to focus on falls as a leading issue.
So, I think it’s an area that we need to keep at the top of our conversations professionally and collaborate in new and innovative ways for how we can impact this important issue.
Kevin Pho: And for those who may not be familiar with the severity of falls and how they could potentially lead to a final decline in a health care setting, what are some of the major reasons, and what are some of the key factors that lead to falls in the first place?
Christine Gall: Yeah, great question. When we look at the environment of a hospital, it’s a very foreign environment for people in general. It’s an intimidating place. When you are in a hospital—being ill and dependent on the system and the people around you—it’s a really challenging place to be.
On top of that, you have factors like injury or illness that may have impacted your strength or your ability to troubleshoot, problem-solve, or just general cognition. Add to that the medications that might be used to treat you, which may affect your independence. Then, if you are in the later stages of life and have the early onset of cognitive decline through dementia or other impacts, you are at great risk while in the hospital seeking care.
In addition to that, the health care workforce is incredibly challenged. We have people leaving at greater numbers than ever before, and we don’t have enough new people entering the profession to fill the void. This impacts our ability to focus on patient safety and maintain programs that address issues like falls.
Kevin Pho: Now, what are some of the traditional measures that health care institutions use to prevent falls? And why do you think, despite these measures, the challenge of falls continues to persist today?
Christine Gall: Well, throughout my career, we have tried many things. I mentioned earlier that I started out in pediatrics, so I had to catch up when I entered the field of adult patient care and quickly recognized the challenges. There are tools like monitors, bed alarms, and sitters who sit one-on-one with patients at the bedside. There are visual reminders asking patients to use their call light instead of attempting to do something independently—all of the above.
But the challenge is that we still don’t have the right mixture of solutions that address each patient’s specific needs and experience of care. When I made the transition from pediatric to adult care, people would ask me, “How on earth did you take care of children who are fragile, sick, and dying?” What was very challenging for me when I started walking the halls of adult care facilities was looking around and seeing the humanness in every bed. I saw that every person was losing some of their independence and even basic human dignity at times.
We need to rethink how we deliver care. Is an alarm that sounds every time a patient moves in their bed the best solution? Or are there other alternatives? That’s what attracted me to Colette Health. When you have a person dedicated to interacting and connecting with a patient to keep them safe and ensure they are continually supported and listened to, that’s crucial.
Sometimes patients need to be redirected when their activities might lead to an injury or fall. Those are the things I think are important for maintaining a safe environment while protecting the dignity of our patients.
Kevin Pho: So let’s talk more specifically about that. Your KevinMD article talks about some of these technological and data-driven solutions, and you alluded to the virtual aspect of care. Can you go into more detail about some of the potential solutions you have to prevent falls?
Christine Gall: We started out in our journey of virtual care very much like our customer colleagues entered virtual care—through direct patient observation. With this model, you have an observer who’s not physically located in the same place as the patient but is able to observe multiple patients simultaneously.
Some of the features that enable them to do that well are AI technologies built into the platform, like motion detection. If you’re watching a panel of, let’s say, 10 or 12 patients as an observer, you can think of them like the tiles in a Brady Bunch grid or a Zoom video. You can move them around so that the most active patients are directly within your line of sight. Patients who are sleeping can be moved to the periphery of your screen.
When patients awaken, it’s one of the most at-risk periods of time. We have technology that recognizes when someone is beginning to awaken and alerts the observer by highlighting that tile. The observer, armed with information from the bedside nurse at shift report, can quickly engage with the patient as they wake up. They can say, “Mr. Jones, how was your sleep? Do you remember that you’re in the hospital? How are you feeling right now? Do you need anything?” That is a subtle but respectful way of supporting the patient, reorienting them to their environment, and ensuring they know someone is there for them.
Kevin Pho: With your virtual observation platform, what are some of the things that the observers would specifically watch for? You mentioned that just a patient getting up puts them at risk for falls. What other signs are they looking for that might warn the bedside nurse that this patient is a particularly high fall risk?
Christine Gall: Definitely. The observer is clued in starting with the information they receive from the bedside nurse at shift report. They’re looking for signs of agitation or for patients who recently received a diuretic and will need to go to the bathroom soon. It’s all about checking in with them so they don’t make that urgent dash to the bathroom to avoid the undignified impact of incontinence—something we can all relate to.
There are also technology aspects, including things like third-party join, which means that in addition to the observer, another party can join that room virtually. For instance, if a patient is beyond consolable and needs to speak to their spouse, we can bring their spouse into the room virtually. It’s about understanding a patient and developing those human connections beyond what the bedside nurse can do in their episodic interactions.
Kevin Pho: Now, is there any data that shows a virtual monitoring platform like this has led to a decrease in patient falls?
Christine Gall: I’m proud to say that throughout our customer base in the last 12 months, we have prevented just under 100,000 falls. Our “good catches” in other areas where we have prevented injury or improved the care team’s ability to address patient-specific issues are innumerable.
It works. We know the technology works. But again, it’s not just about the platform. It’s about savvy leadership and savvy implementation of the platform. The technology has to be trusted and adopted by the staff on the unit. Without that part of the equation, we all know about the closets or drawers on every unit with the latest best idea that got shelved because nobody wanted to deal with it.
That’s the difference that Colette Health brings to the table. We want to be the implementation partner—not just sell you something and walk away—because in order to deal with patient falls, which is one of our top priorities, we need to make sure the systems and leadership in place around that technology are agile, efficient, and effective.
Kevin Pho: We’re talking to Christine Gall. She’s a nurse executive. Today’s KevinMD article is titled, Embracing Data-Driven Solutions to Prevent Falls. Christine, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.
Christine Gall: Oh, well, thanks again, Kevin, for having me here. I think we are in a period of time in health care that I’ve never seen before. This is our opportunity. We have the acceleration and interest to bring virtual technology into patient care, but we need to do that in a thoughtful manner. We also need to prepare our leaders to be able to lead in this new frontier of virtual care and understand how and when to incorporate virtual aspects into the delivery of human-centered patient care to improve outcomes, safety, and the experience of care for both clinicians and patients.
We also need to recognize that this isn’t a one-size-fits-all solution. We need to look at the major problems and challenges of our particular patient populations and address them through custom, purpose-built programs that best leverage the technology available. When choosing partners to address these problems and bring virtual care in, make sure that who you choose not only has the technology but also has the leadership and programmatic experience to help you execute a successful program.
We need to bring our staff to a place where they are ready, willing, and able to adopt new changes in their workflow to improve the outcomes that are desired from virtual care.
Kevin Pho: Christine, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Christine Gall: Kevin, thanks so much.
