Abstracts

Rationale: Every year, 70,000 to 1,000,000 falls occur in hospitalized patients in the United States. Each fall can extend length of stay by an average of 12.3 days leading to worse prognosis and 61% more in costs, or about $4,200 in comparison to patients who don’t fall.¹ Epilepsy patients are at 2-6x greater risk for skeletal fractures with falls than the general population.² This risk is increased in the epilepsy monitoring unit (EMU) where anti-seizure medications (ASMs) are lowered, which can result in more severe and frequent seizures than their baseline. To mitigate this fall risk, patient mobility including bathroom privileges is limited with recommendation for use of bedside commode for high fall risk patients based on the Yale New Haven Health hospital fall prevention guidelines. Unfortunately, this mobility restriction and use of bedside commode can be distressing to patients, sometimes with premature termination of the EMU study. In our EMU, this occurred in 4 patients within a 3 month period. To minimize fall risk and improve patient satisfaction, we developed a fall risk algorithm along with inpatient and outpatient EMU education to improve EMU tolerability.   

Methods: A multidisciplinary committee involving provider, nursing and clinical neurophysiology developed a fall risk assessment. This assessment is performed on admission and reassessed daily. Fall risk was stratified as Low, Medium, or High (see Figure for details). Each category defined the patient’s mobility and bathroom privileges and an order set was created. Those with Low or Medium risk are granted "bathroom privileges with constant supervision," while patients with High risk are ordered to have “bedside commode with constant supervision" and privacy screen offered. Improved education was given to patients prior to EMU admission regarding their risk of falls and bathroom privileges. This included education during clinic visit, pre-admission calls, and revising the EMU admission letter. The inpatient EMU team streamlined communication from medical staff to patients on the first day of admission for transparency and to set expectations.      

Results: Since the risk assessment was implemented in May 2021, about 44.6% of patients admitted to our EMU were categorized in the high fall risk category and about 55.4% in the low and medium fall risk category. Approximately 50% of the high risk fall patients opted for use of the patient privacy screen. Zero patients left the EMU prematurely and zero falls occurred since implementation of the fall risk algorithm and education program. Prior to this change, there were 4 prematurely terminated EMU admissions over a 3 month period and 3 falls in the EMU that occurred over an 11-month period.  

Conclusions: Pre-EMU education on our fall risk algorithm along with daily real time fall risk assessment can lead to safe and tolerable admissions for patients in the EMU. 

References:
1. Kafantogia K, Katsafourou P, Tassiou A, Vassou N. Falls among hospitalized patients. J Frailty Sarcopenia Falls. 2017;2(3):53-57. Published 2017 Sep 1._x000D_ 2. Mattson RH, Gidal BE. Fractures, epilepsy, and antiepileptic drugs. Epilepsy Behav. 2004;5 Suppl 2:S36-S40. 

Funding: None