Decreasing Falls on Brain Injury Rehab Unit

Project Topic:

Decreasing falls

Hospital, City and State:

The University of Alabama-Birmingham Health System, Birmingham, Alabama

Unit:

• Brain Injury Recovery Program

CSI Participants:

• Margaux A. Jones, BSN, RN
• Christel Lee, LPN, BHRM
• ShaRita Kyle Mitchell, RN, MSHQS, CRRN

Project Goals/Objectives:

1. Decrease patient falls 20%
2. Increase Healthy Work Environment Assessment Tool (HWEAT) scores for True Collaboration and Skilled Communication to 4.2

Project Outcomes:

1. Increased patient falls 40%
2. Decreased HWEAT aggregate score and 5/6 standards

Project Overview:

The Brain Injury Recovery Program (BIRP) at the University of Alabama at Birmingham (UAB) Rehabilitation Pavilion launched the “No Booties on the Ground” initiative to reduce patient falls, strengthen interdisciplinary teamwork, and improve communication among nursing staff, rehabilitation teams, virtual sitters, patients, and families. The 26-bed inpatient rehabilitation unit serves a high-risk population of patients recovering from traumatic and non-traumatic brain injuries, stroke, spinal cord injuries, and other neurological conditions, making fall prevention a critical patient safety priority.

The project team implemented a comprehensive fall prevention strategy that included bedside shift reporting, purposeful rounding, scheduled toileting, standardized patient care technician rounding protocols, enhanced communication with virtual sitters, improved call light response processes, and patient and family education regarding transfer expectations. Staff engagement was further supported through educational events, themed project activities, and ongoing recognition efforts designed to promote participation and reinforce safety-focused behaviors.

Although the project's primary goal of reducing falls was not achieved, the initiative provided valuable insights during a period of significant organizational change. During implementation, the unit transitioned from an 18-bed unit to a larger 26-bed facility, while simultaneously experiencing increased patient census, workflow redesign, staffing challenges, and new operational demands. Falls increased from 35 during the baseline period to 49 during the post-implementation period. Rather than reflecting a failure of the interventions themselves, these results highlighted the substantial impact that environmental transitions, increased patient volume, alarm fatigue, delayed response times, and evolving workflows can have on patient safety outcomes.

Despite the increase in falls, the project generated several meaningful successes. Staff participation in Healthy Work Environment Assessment Tool surveys increased, awareness of fall prevention strategies improved, interdisciplinary communication became stronger, and important workflow barriers were identified that may not have otherwise been recognized. The team also reported improved patient-staff rapport, more coordinated care planning, earlier identification of changes in patient condition, and a reduced need for some as-needed medications. These outcomes suggest that the project strengthened collaboration and patient-centered care, creating a stronger foundation for future fall prevention efforts.

Perhaps most importantly, the initiative provided the organization with a clearer understanding of the challenges associated with caring for a complex rehabilitation population during a major unit expansion. The lessons learned regarding staffing, virtual sitter communication, response processes, and environmental design have created actionable opportunities for future quality improvement work. By identifying these barriers and establishing ongoing fall committee reviews, staff education, and competency-based training, the BIRP team has positioned itself to build upon this experience and develop more effective fall prevention strategies moving forward.