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Biomechanical Determination of Safe Footwear for Institutional Patients
JAMDA 16 (2015) B26eB30
JAMDA journal homepage: www.jamda.com
Research
Research Category Biomechanical Determination of Safe Footwear for Institutional Patients Presenting Author: Tatjana Bulat, MD, CMD, VISN 8 Patient Safety Center of Inquiry Author(s): Tatjana Bulat, MD, CMD; and John Lloyd, PhD
Introduction/Objective: Slips and trips often cause unintended falls. A slip occurs when the coefficient of friction between the flooring and footwear surfaces is too low, whereas a trip may occur if the coefficient of friction is too high. The optimum coefficient of friction ratio between footwear and flooring is 0.5 to 0.7. Many variables affect this ratio, including condition of footwear, floor materials, and conditions (e.g. wetness). Many products are available on the market, but no guidance exists to guide decision making. Our objective was to systematically evaluate different types of footwear against various flooring materials under both dry and wet conditions. Design/Methodology: Using a ComTen Materials Testing System, we measured both the static and dynamic coefficient of friction over time for the different footwear/flooring/condition combinations. The footwear tested included nylon anti-slip socks, sneakers, dress shoes, Crocs, sandals and flip-flops, against different flooring materials [VCT(vinyl composite tile) , wood, commercial and residential carpet, smooth and rough tile] under dry and wet conditions in a laboratory setting. Five repeated measures were acquired for each combination and the average calculated. Results: With respect to the VCT flooring surface that is typically used in hospital and nursing home settings, the Croc footwear, considerably outperformed all other tested footwear in dry condition with lbF (force to overcome coefficient of friction between footwear and flooring) of 4.56. Non-slip socks were the least effective footwear under dry conditions across all flooring surfaces investigated (e.g for VCT, 2.48 lbF) and were only under-performed by flip-flops in wet conditions (1.76 lbF for VCT). Conclusion/Discussion: The utility of ‘non-slip socks’ should be questioned, as these were among the worst performers under both wet and dry conditions across all flooring surfaces and specifically on VCT flooring, which is flooring surface of choice in many hospitals and nursing homes. CrocsTM or sneakers appear to be the footwear of choice to decrease risk of slips in institutional settings. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
Connected Care SNFs vs Usual Care SNFs regarding 30 Day Readmissions Rates Presenting Author: Do Gyun Kim, MD, Cleveland Clinic Author(s): Do Gyun Kim, MD, Renato Samala, MD, Leah Beegan, MD, Daniel Blechschmid, NHA; and Michael Felver, MD
Introduction/Objective: About 20% of hospitalized Medicare Beneficiaries were discharged to Skilled Nursing Facilities(SNFs) for post-acute care 1525-8610/Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
(PAC) in 2011. In 2014, the Office of Inspector General (OIG) reported that 33% of Medicare beneficiaries in SNFs experienced adverse events, and physician reviewers determined that 59% of these events were clearly or likely preventable. Cleveland Clinic started Connected Care SNF program to ensure the quality of the care at SNFs on 2012. Currently 7 SNFs near Cleveland Clinic have been active Connected Care SNF sites to improve the quality of PAC. We wanted to compare 30 day readmissions rates of Connected Care SNFs and usual care SNFs. Design/Methodology: Retrospective cohort, Cleveland Clinic Main Campus discharge patients who were discharged to Top 50 SNFs between 2013 November to 2014 April. (N¼1724) Administrative Data review. T-test and Chi-square test was used. Results: Connected Care SNFs and usual care SNFs were compared. Gender, number of admissions within one year, length of stay of index hospitalization, MSDRG weight, HOSPITAL score, AM-PAC TM score, number of scheduled medication on discharge, dialysis status and oncology service discharge were not different. Connected Care SNFs had more African American (p<0.0001), more older population (p<0.0001) and more medicine patients (p¼0.0011). Usual care SNFs had more elective admissions (p¼0.0013). Conclusion/Discussion: Connected Care SNF’s 30-day readmissions were lower than usual care SNFs. (21.46% vs 35.67%, p<0.0001). In this study, Connected Care SNFs had less readmissions. Daily rounding of provider, using the same electronic medical record, higher nursing ratio, monthly Joint Quality meeting and administration’s effort to deliver quality care may reduce 30-day readmissions on tertiary academic center discharged patients to SNFs. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
Effect of Implementation of the Tele-Health Visiting Nurse Association Project on Re-Hospitalization Rate and Cost Presenting Author: Murthy Gokula, MD, CMD, University of Toledo Author(s): Murthy Gokula, MD, CMD, Phyllis Gaspar, PhD, RN, Bethany King, MSN, RN, Charles Moore; and Xuan Li, MPH
Introduction/Objective: Tele-health is gaining attention as an approach to prevent re-hospitalization. In the rural areas of Ohio the ability to connect those recently discharged with a health care professional on a routine basis as well as when facing a change in condition has the potential to prevent rehospitalization. This project evaluated the use of tele-health in the potential prevention of re-hospitalization as well as look at the cost-benefit analysis. Design/Methodology: The project provided clinical follow-up care to recently discharged patients noted as at risk for re-hospitalization. Tele-health equipment was placed in the home for daily monitoring with follow up by the appropriate health care provider. Data from the health records for clients of a rural based VNA, both those who received tele-health and a comparison group, were downloaded from the electronic records and de-identified. Results: Among the 284 recipients of tele-health over the year period only 21 (7%) had an acute care transfer. Based on nurse judgment 98 on-site visits were prevented over the year through the tele-health visits. These prevented
JAMDA journal homepage: www.jamda.com
Research
Research Category Biomechanical Determination of Safe Footwear for Institutional Patients Presenting Author: Tatjana Bulat, MD, CMD, VISN 8 Patient Safety Center of Inquiry Author(s): Tatjana Bulat, MD, CMD; and John Lloyd, PhD
Introduction/Objective: Slips and trips often cause unintended falls. A slip occurs when the coefficient of friction between the flooring and footwear surfaces is too low, whereas a trip may occur if the coefficient of friction is too high. The optimum coefficient of friction ratio between footwear and flooring is 0.5 to 0.7. Many variables affect this ratio, including condition of footwear, floor materials, and conditions (e.g. wetness). Many products are available on the market, but no guidance exists to guide decision making. Our objective was to systematically evaluate different types of footwear against various flooring materials under both dry and wet conditions. Design/Methodology: Using a ComTen Materials Testing System, we measured both the static and dynamic coefficient of friction over time for the different footwear/flooring/condition combinations. The footwear tested included nylon anti-slip socks, sneakers, dress shoes, Crocs, sandals and flip-flops, against different flooring materials [VCT(vinyl composite tile) , wood, commercial and residential carpet, smooth and rough tile] under dry and wet conditions in a laboratory setting. Five repeated measures were acquired for each combination and the average calculated. Results: With respect to the VCT flooring surface that is typically used in hospital and nursing home settings, the Croc footwear, considerably outperformed all other tested footwear in dry condition with lbF (force to overcome coefficient of friction between footwear and flooring) of 4.56. Non-slip socks were the least effective footwear under dry conditions across all flooring surfaces investigated (e.g for VCT, 2.48 lbF) and were only under-performed by flip-flops in wet conditions (1.76 lbF for VCT). Conclusion/Discussion: The utility of ‘non-slip socks’ should be questioned, as these were among the worst performers under both wet and dry conditions across all flooring surfaces and specifically on VCT flooring, which is flooring surface of choice in many hospitals and nursing homes. CrocsTM or sneakers appear to be the footwear of choice to decrease risk of slips in institutional settings. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
Connected Care SNFs vs Usual Care SNFs regarding 30 Day Readmissions Rates Presenting Author: Do Gyun Kim, MD, Cleveland Clinic Author(s): Do Gyun Kim, MD, Renato Samala, MD, Leah Beegan, MD, Daniel Blechschmid, NHA; and Michael Felver, MD
Introduction/Objective: About 20% of hospitalized Medicare Beneficiaries were discharged to Skilled Nursing Facilities(SNFs) for post-acute care 1525-8610/Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
(PAC) in 2011. In 2014, the Office of Inspector General (OIG) reported that 33% of Medicare beneficiaries in SNFs experienced adverse events, and physician reviewers determined that 59% of these events were clearly or likely preventable. Cleveland Clinic started Connected Care SNF program to ensure the quality of the care at SNFs on 2012. Currently 7 SNFs near Cleveland Clinic have been active Connected Care SNF sites to improve the quality of PAC. We wanted to compare 30 day readmissions rates of Connected Care SNFs and usual care SNFs. Design/Methodology: Retrospective cohort, Cleveland Clinic Main Campus discharge patients who were discharged to Top 50 SNFs between 2013 November to 2014 April. (N¼1724) Administrative Data review. T-test and Chi-square test was used. Results: Connected Care SNFs and usual care SNFs were compared. Gender, number of admissions within one year, length of stay of index hospitalization, MSDRG weight, HOSPITAL score, AM-PAC TM score, number of scheduled medication on discharge, dialysis status and oncology service discharge were not different. Connected Care SNFs had more African American (p<0.0001), more older population (p<0.0001) and more medicine patients (p¼0.0011). Usual care SNFs had more elective admissions (p¼0.0013). Conclusion/Discussion: Connected Care SNF’s 30-day readmissions were lower than usual care SNFs. (21.46% vs 35.67%, p<0.0001). In this study, Connected Care SNFs had less readmissions. Daily rounding of provider, using the same electronic medical record, higher nursing ratio, monthly Joint Quality meeting and administration’s effort to deliver quality care may reduce 30-day readmissions on tertiary academic center discharged patients to SNFs. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
Effect of Implementation of the Tele-Health Visiting Nurse Association Project on Re-Hospitalization Rate and Cost Presenting Author: Murthy Gokula, MD, CMD, University of Toledo Author(s): Murthy Gokula, MD, CMD, Phyllis Gaspar, PhD, RN, Bethany King, MSN, RN, Charles Moore; and Xuan Li, MPH
Introduction/Objective: Tele-health is gaining attention as an approach to prevent re-hospitalization. In the rural areas of Ohio the ability to connect those recently discharged with a health care professional on a routine basis as well as when facing a change in condition has the potential to prevent rehospitalization. This project evaluated the use of tele-health in the potential prevention of re-hospitalization as well as look at the cost-benefit analysis. Design/Methodology: The project provided clinical follow-up care to recently discharged patients noted as at risk for re-hospitalization. Tele-health equipment was placed in the home for daily monitoring with follow up by the appropriate health care provider. Data from the health records for clients of a rural based VNA, both those who received tele-health and a comparison group, were downloaded from the electronic records and de-identified. Results: Among the 284 recipients of tele-health over the year period only 21 (7%) had an acute care transfer. Based on nurse judgment 98 on-site visits were prevented over the year through the tele-health visits. These prevented