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Using Process Improvement Methodology to Address the Complex Issue of Falls in the Inpatient Setting

Christopher, Deborah A. MSN, RN, CPHQ; Trotta, Rebecca L. PhD, RN; Yoho, Margaret A. MSN, RN; Strong, Jocelyn MSN, RN, PCCN; Dubendorf, Phyllis MSN, RN, CCNS, CNRN

doi: 10.1097/NCQ.0000000000000053

Falls in the acute care hospital are a significant patient safety issue. The purpose of this article was to describe the use of process improvement methodology to address inpatient falls on 5 units. This initiative focused on a proactive approach to falls, identification of high-risk patients, and a complete assessment of patients at risk. During the project timeframe, the mean total fall rate decreased from 3.7 to 2.8 total falls per 1000 patient days.

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Hospital of the University of Pennsylvania, Philadelphia (Mss Christopher, Yoho, and Dubendorf and Dr Trotta); and Clinical Solutions Group, Kronos Incorporated, Chelmsford, Massachusetts (Ms Strong).

Correspondence: Deborah A. Christopher, MSN, RN, CPHQ, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA, 19107 (

The authors declare no conflicts of interest.

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Accepted for publication: January 1, 2014

Published ahead of print: February 4, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins