Hospital Fall Prevention
A Systematic Review of Implementation, Components, Adherence, and Effectiveness
Published in: Journal of the American Geriatrics Society, v. 61, no. 4, Apr. 2013, p. 483-494
Posted on RAND.org on January 01, 2013
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- How effective are efforts in U.S. hospitals to prevent in-patient falls?
OBJECTIVES: To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals. DESIGN: Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011. SETTING: U.S. acute care hospitals. PARTICIPANTS: Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before–after studies). INTERVENTION: Fall prevention interventions. MEASUREMENTS: Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details. RESULTS: Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52–1.12, P = .17; eight studies; I2: 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR. CONCLUSION: Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.
Establishing evidence of how hospitals can prevent falls will require better reporting of outcomes, implementation, adherence, and components of existing approaches, as well as information about comparison groups.
Providers who are attempting to implement measures to reduce in-patient falls may benefit from reviewing the successful studies documented in this systematic review and pursuing approaches that are most compatible with their hospital culture and patient populations.