Multidisciplinary Testing of Floor Pads on Stability, Energy Absorption, and Ease of Hospital Use for Enhanced Patient Safety Barbara Crane, PT, PhD,* Adam D. Goodworth, PhD,* Melissa Liquori, BS,Þ Suhash Ghosh, PhD,þ Catherine Certo, PT, ScD,* and Lorraine McCafferty, RN, MSN§ Objectives: A major improvement in hospital safety could be realized if serious injury did not accompany falls. We studied several commer- cially available floor pads made of different materials to determine which (if any) would be practical in a hospital room and reduce injury without posing a threat to the balance of patients. Methods: A multidisciplinary approach was undertaken to (1) mea- sure upper and lower body motion in 17 young (G50 years) and 17 older (955 years) adults during an instrumented sit to stand test from a hos- pital bed onto the different floor pads, (2) predict the energy dissipation available in floor pads by quantifying the relative mechanical properties, and (3) obtain professional feedback from hospital nurses via a ques- tionnaire (8 questions) following a period of working on the different floor pads. Five floor pads, composed of foam, gel, and/or rubber were tested. All pads were compared with a typical hospital floor (concrete covered with linoleum tiles, considered the control). Results: All of the pads subject to mechanical testing showed at least 3 times more energy absorption compared with the control. Balance testing showed that three of the pads resulted in minimal or no signifi- cant increases in body motion during sit-to-stand. Nursing feedback revealed that only 2 of these 3 pads may be feasible for hospital room use: one made primarily of firm rubber and one made of foam. Conclusions: Floor pads do exist that show promise for hospital use that absorbing energy without major impacts on balance during sit-to-stand. Although only commercially available pads were investigated, results may inform the design and multidisciplinary testing of other floor surfaces. Key Words: hospital falls, injury, balance, floor pad (J Patient Saf 2014;00: 00Y00) F alls resulting in hip fractures are a worldwide health con- cern 1 and a problem that disproportionately affects older adults. Because of changes in demographics of this population and the aging of the ‘‘baby boom’’ generation, the number of hip fractures worldwide is expected to near 6.3 million by the year 2050. 1 Injuries arising from fall related accidents in all environments are a major health-care concern for older adults, 2 particularly in locations where there are high concentrations of this at-risk population, such as residential care facilities, hos- pitals, and senior centers. 3 In a study of residents in nursing homes and assisted living environments, Tideiksaar 4 found that 30% to 50% of residents fall annually and up to 40% of resi- dents experience recurrent falls. Falls in hospital settings are a less studied but no less im- portant concern. Falls in hospitals constitute a major health care concern in many parts of the world, including the United King- dom, 5 Australia, 6 and the United States. 7Y9 In a reported study of adverse events in Veteran’s Affairs hospitals, falls made up 47% of all safety reports for the year 2003. 6 Likewise, Morgan et al 9 described falls as ‘‘consistently the largest single category of hospital inpatient incident in reports published since the 1940’s,’’ 9 and Kolin et al 10 described falls as one of the biggest categories of reported adverse events and estimated costs at more than $20 billion per year. Reported hospital falls range in frequency from 2.3 to 11.5 falls per 1000 patient days and affect young as well as older individuals. 7,8 Falls in older individuals are of par- ticular concern as they are at higher risk of serious fall-related injuries because of comorbidities such as osteoporosis. Falls in hospital settings are not only concerning because of their persistent epidemiological existence but also because of their effects on patients (i.e., injuries), their effects on health- care costs and policy, and their effects on perceived quality of health-care delivered in hospital settings. Although the majority of hospital falls result in no discernible injury, 9 the injury rate has been reported as high as 25%, and the occurrence of serious injuries (including fractures) ranges from 2% to 10%. 7,9 Falls with injuries impact the length and cost of hospital stays for many patients, 10,11 adding as much as $4,000 in excess cost related to care for any one incident. 10 Hospital falls also have an impact on the attitudes of staff and the perceived quality of care of the hospital itself. 11 Additional motivation to solve this troubling concern is provided by health-care policymakers in the United States. As of 2008, hospital falls are included in the list of eight ‘‘secondary conditions’’ that are considered pre- ventable and therefore will not be considered for additional payments to hospitals to cover any resulting costs. 6,12 This rel- atively new rule results in hospitals experiencing reduced pay- ment for the care of individuals who fall and sustain an injury during their hospital stay, placing increased responsibility on them to prevent these injuries or bear the resulting costs. 12 This change may be reflective of a shift in overall health policy fo- cusing onquality care and ‘‘pay for performance.’’ 12 There are 4 primary research approaches related to hospital falls: epidemiological, medical prevention strategies, biome- chanical studies, and environmental. 13 Researchers have focused on developing an understanding of risk factors to ‘‘screen’’ or predict patients who may be at high risk of falls. 5,8,14Y16 Signif- icant efforts are reported in the literature regarding development of effective screening tools and implementation of preventative measures, primarily focused around changes in patient care rou- tines. 15,17 Systematic reviews and meta-analyses of existing studies have found fall prevention strategies largely ineffective in ORIGINAL ARTICLE J Patient Saf & Volume 00, Number 00, Month 2014 www.journalpatientsafety.com 1 From the *University of Hartford, Rehabilitation Sciences Department, †University of Hartford, Biomedical Engineering Department, ‡University of Hartford, Mechanical Engineering Department, West Hartford; and §Saint Francis Medical Center, Hartford, Connecticut. Correspondence: Barbara Crane, PT, PhD, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117 (e<mail: bcrane@hartford.edu). This study was funded through a grant provided by the Saint Francis Care/ University of Hartford Collaborative Agreement, RFP: ‘‘Focus on Falls Initiative - 2010.’’ Additionally, in-kind support was provided via the donation of the gel pad by Innovative Medical Products, Plainville, CT. No conflicts of interest were declared by any of the authors. Copyright * 2014 by Lippincott Williams & Wilkins Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.