Article warns CMS policy on falls may lead to greater use of restraints

Writing in today's New England Journal of Medicine, Dr. Sharon K. Inouye of Harvard Medical School and her coauthors argue that because falls have proved to be such an intractable problem despite broad efforts to reduce them, they should not be included on a list of avoidable medical errors that result in hospitals not being paid.


According to the Boston Globe, Dr. Inouye is warning the pressure to keep patients from falling may lead to greater harm through the use of restraints, reversing a trend of greater mobility among hospitalized patients. Without well-established guidelines on preventing falls, Inouye said she fears restraints will be used. "We have to do something to counteract what may be people's natural tendency to think to stop falls, we've got to tie everyone up," Inouye said in an interview. "We want to open people's eyes to the fact that restraints are actually associated with lots of complications."


Up to one of five patients fall at least once during their time in the hospital, leading to injuries, longer stays, lawsuits, and hospital bills higher by about $4,000, according to previous research cited in the opinion piece. Falls are often caused by the illnesses or impairments patients have and the medications and other treatments they receive to treat them, Inouye said, meaning falls can happen despite the best hospital care.


In October 2009, the federal government stopped paying hospitals for extra care if a patient fall was deemed preventable, according to


Dr. Thomas Valuck, medical officer and senior adviser at the Center for Medicare Management at the Centers for Medicare & Medicaid Services told he believes Inouye's policy encourages alternatives to restraints and it "is appropriate to use the Medicare payment incentive to encourage adherence to those best practices."


(SOURCES: HCPro Accreditation Connection,, June 8, 2009; The Boston Globe,, accessed June 8, 2009)