Designing adverse event prevention programs using quality management methods: the case of falls in hospital.
OBJECTIVE
From a public health perspective, the effectiveness of any prevention program depends on integrated medical and managerial strategies. In this way, quality management methods drawn from organization and business management can help design prevention programs. The aim of this study was to analyze the potential value of these methods in the specific context of preventing falls in hospital.


METHODS
Medical and Rehabilitation Care Unit of Saint-Maurice National Hospital (France).


METHODS
In phase 1, two surveys assessed the context in which falls occurred. The first survey (1995) quantified adverse events during a 1-year period (n = 564) and the second (1996-1997) documented the reasons for falls (n = 53). In phase 2, a set of recommendations to prevent falls was elaborated and implemented throughout the hospital.


RESULTS
The fall frequency in this unit was 18.3% in 1995. Analysis showed organizational causes in 35 (66%) of the 53 documented falls; 24 of them were associated with individual factors. Even though the two categories of causes are interdependent, their distinction enables specific recommendations. The proposed organizational management changes recommended do not aim to achieve an illusory objective of 'zero falls', but are designed to reduce the number of avoidable falls and to limit the negative consequences of unavoidable falls.


CONCLUSIONS
Quality improvement methods shed new light on how to prevent falls. An unexploited potential for prevention lies in organization and management of care for hospitalized patients.
Grenier-Sennelier
Catherine
C
Groupe Image-National School of Public Health, Saint-Maurice National Hospital, France.
Lombard
Isabelle
I
Jeny-Loeper
Catherine
C
Maillet-Gouret
Marie-Christine
MC
Minvielle
Etienne
E
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D005602:France; D006302:Health Services Research; D006801:Humans; D008297:Male; D016730:Program Development; D012047:Rehabilitation Centers / Q000458:organization & administration* / Q000592:standards; D012308:Risk Management / Q000379:methods*; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*