Children with physical or cognitive disabilities can be at higher risk for patient safety events, such as falls.

A multidisciplinary research team in the inpatient rehabilitation unit at the Texas Children’s Hospital and Baylor College of Medicine developed the Stoplight Mobility Alert System (SMAS) to better guide the level of assistance for children with physical and cognitive impairments. The SMAS was developed as an adjunct to the existing institutional fall prevention bundle and to address intrinsic factors (cognition, physical deficits).

Based on a fall risk assessment and the patient’s locomotion score (walk, wheelchair, crawl), they are assigned a color in the SMAS:

• Red = patients requiring hands-on assistance at all times
• Yellow = patients requiring close supervision
• Green = patients does not require assistance

After admission, all patients are placed on a red mobility alert until a fall risk-assessment is completed by the healthcare team. Afterwards, the mobility evaluation is communicated to the bedside nurse and documented in the nursing communication. Mobility alert status is also discussed with the family and in the next morning’s interdisciplinary huddle. A colored alert system is then placed on the patient’s door, serving as a visual clue of the patient’s mobility score for the healthcare team and other staff. Education and one-on-one education for staff, patients and families is also provided.

One year after SMAS implementation, the research team documented a 60% decrease in the rate of total falls. The research team also noted sustained improvements in falls, reporting a 31% decrease across longitudinal follow-up from 2015 to 2022, as well as a 33% decrease in falls due to intrinsic factors.