Novel approaches at St. Luke’s lead to major reductions of in-hospital injuries

At St. Luke’s, safety is paramount. In virtually every corner, you will find that commitment, along with the goal of “zero preventable harm.”

That goes for frontline staff and patients alike.

Unfortunately, on rare occasions in medical settings, there are health care-acquired conditions that may lead to longer stays or may require further treatment. Such events occur at any medical facility, but St. Luke’s has made excellent strides as the result of a two-year effort to reduce the primary causes of those conditions.

“It aligned with that goal of zero preventable harm … we knew better performance was achievable,” said Bethany Rogers, system director of performance improvement. “We wanted to make sure it wasn’t sleepy background work, but to have it front and center.”

Though implementing major initiatives can take some time, the process was a success thanks to the frontline teams performing the actions and staff analyzing data to address weak points.

“Nurses and everyone on those floors have so many priorities, so our goal was ‘how do we make the right thing the easy thing?’” said Mandy Studebaker, a physician assistant and performance improvement specialist.

The three most common adverse conditions acquired at health care facilities — injuries from falling, hospital-acquired pressure injuries and catheter-associated urinary tract infections — were the focus of the “all hands on deck” push. And the results were outstanding.

Injury falls prevention

The most common injury in a clinical setting, St. Luke’s saw a 59% decrease in falls with serious injury from 2023 to 2024. The pilot location for the program, St. Luke’s Meridian, experienced a 21.3% decrease in total falls.

Recently, the team on the sixth floor in the Meridian Medical Center was recognized for their significant progress in reducing patient falls. The unit is among the most challenging for fall prevention, seeing a high number of patients with behavioral health issues and cognitive impairments.

“Honestly, I was a little bit stunned at how well we did with our goals, reducing those serious injuries from patients falling,” said Stuart Carson, a performance improvement specialist. “The chart kept dropping, and it was like, ‘wow,’ especially in areas like that (in Meridian). It’s been really great seeing it around the system.”

So, how did the team do it?

In addressing fall risk, research showed that patients may not be fully aware of, well, how at-risk they might be. They are in a new environment, no carpet on the floor, a different bed, often taking medications and potentially connected to medical equipment … the list goes on.

Patient-facing whiteboards were created to help patients understand their unique fall risk factors, along with signage, such as “call, don’t fall,” to reiterate if they need to contact staff to get up.

And for frontline teams, it is small improvements, like streamlining documentation at the beginning of the patients’ stay, checking boxes in a report instead of having to write things out or communicating earlier about fall risks.

Formerly, a notation would be made on a patient’s door that they were high risk for a fall, but it was found that many falls came from those who thought they were at little to no risk.

“It informs fall status in a very clear way that is now standard for med-surg units across the system,” Carson said. “One of the biggest changes we made as a system was that everyone is a fall risk, which keeps it in mind for our teams but also the patients, too.”

Hospital-acquired pressure injury prevention

A hospital-acquired pressure injury, known as a HAPI, is a localized injury that appears on the skin and extends to the tissue beneath, often near a bony part of the body, that can develop when there is prolonged pressure in one location.

Though a patient may come to a facility for a need that only requires a short stay, if a major HAPI occurs, wound treatment could continue for weeks or months. According to the National Institutes of Health, approximately 2.5 million individuals develop a pressure injury in acute care facilities each year in the U.S.

Since early 2023, the rate of HAPIs found among patients in quarterly surveillance studies decreased by 42%. In 2024, St. Luke’s had its best survey ever, with only 1% of surveyed patients having a new pressure injury. 

“It’s super exciting and makes me incredibly proud of the team,” Studebaker said. “It’s one thing to find where energies need to be focused, then finding ideas on how to improve, and finally executing. Our staff has been fantastic being open to those changes.”

Like fall prevention, a key to reducing HAPIs takes place right at the start — noting any potential areas of concern or pre-existing skin or tissue injuries. Banners in the patients’ medical records also are created and automatically link to resources to help.

Offloading the areas of potential injury is important and now easier. Previously, to get certain equipment, a call would be placed to a distribution center at the hospital, but now that equipment has been moved to locations on the floor, providing easier and faster access.

Some patients cannot reposition themselves, so “turn teams” were created, in which every two hours, two staff members make the rounds together to get patients moved around properly. Since the pairs change, it also gives frontline teams more time for their patients, adds accountability and even reduces risk for injury to staff, with two people assisting instead of just one.

“Some may not feel it if they have a HAPI,” Studebaker said. “Even healthy people can get it — no one is exempt, so having everyone aware pays off.”

Catheter-associated urinary tract infection prevention

In preventing a catheter-associated urinary tract infection, or CAUTI, St. Luke’s has seen some great successes the last two years. In 2023, the health system experienced its lowest rate since 2019 and then reduced that number even more the following year, reporting several months without a CAUTI during that span.

“We’ve had some great success there, really proud of that,” Rogers said.

Rogers noted that there are two major aims with CAUTI prevention. The first is simple: avoiding using a catheter altogether, where possible. Second, if one is placed, doing so in a sterile manner, being diligent about proper hygiene practices thereafter, and removing it as soon as is reasonable.

That first piece has been key; placing a catheter is a high-risk decision and there are alternatives. Rogers indicated that, while sterile catheter placement has not historically contributed to CAUTIs at St. Luke’s, health system teams found that they could make the ongoing care of a catheter easier and more successful.

“If you’re putting in fewer catheters and removing earlier, you’ll have fewer catheter days — but your denominator is getting smaller, so the CAUTI rate can appear higher … what we found, however, was that both the days and the infections decreased, which was wonderful to see,” Rogers said.