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Monique Kroeker, a physiotherapist at Toronto Western Hospital (TWH), worked on the rapid improvement event (RIE) team responsible for developing a falls prevention process that allowed 5A, a spine inpatient unit at TWH, to go 48 days without a fall.
She recently moved up one floor to 6A, a stroke inpatient unit, and not long after, was asked to participate in another falls prevention RIE on her new unit.
"My first thought, if I'm being honest, was that we were duplicating work," says Monique. "Why not just take the work we did on 5A and bring it over?"
Every RIE begins with Lean training, followed by a data presentation that highlights potential causes for whatever issue the team is working on.
"As soon as I saw the data presentation on Monday morning, I realized why we couldn't duplicate the work from the previous team," says Monique. "The root causes for the falls on 6A were totally different from the root causes on 5A."
In the first event on 5A, the team learned that almost half the falls occurred during the night shift, between midnight and 6 a.m.
In the second event on 6A, the data showed three main factors: Falls occurred during shift changes in the morning and evening, when family members attempted to help patients mobilize, and during the first 24 hours of admission.
"We borrowed from the work done in the first event because a lot of it was still applicable," says Monique. "That gave us time to develop countermeasures that targeted our unique challenges. We don't have cookie cutter problems, so cookie cutter solutions won't work."