Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies

Abstract

Results:In phase 1 five factors were independently associated with a higher risk of falls: fall as a presenting complaint (odds ratio 4.64 (95% confidence interval 2.59 to 8.33); a transfer and mobility score of 3 or 4 (2.10 (1.22 to 3.61)); and primary nurses' judgment that a patient was agitated (20.9 (9.62 to 45.62)), needed frequent toileting (2.48 (1.08 to 5.70)), and was visually impaired (3.56 (1.26 to 10.05)). A risk assessment score (range 0-5) was derived by scoring one point for each of these five factors. In phases 2 and 3 a risk assessment score > 2 was used to define high risk: the sensitivity and specificity of the score to predict falls during the following week was 93% and 88% respectively in phase 2 and 92% and 68% respectively in phase 3. Conclusion:This simple risk assessment tool predicted with clinically useful sensitivity and specificity a high percentage of falls among elderly hospital inpatients.

Preoperative Patient Education Reduces In-hospital Falls After Total Knee Arthroplasty

“…Consequences of these falls include morbidity for the patient and regulatory and financial liability for the institution. For all these reasons, fall reduction has become a high priority for hospitals throughout the United States and numerous studies have been conducted to understand when and why these falls occur [2,4,10,12,15,16]. While several studies [5-8, 18, 21] have evaluated the effectiveness of particular strategies to reduce falls, the fall reduction programs that reduce falls among inpatients have frequently incorporated multimodal intervention strategies, rather than focusing on one specific variable.…”

“…Therefore, underlying differences in the two groups may account for the observed differences in outcomes. Specifically, we did not evaluate other variables, such as comorbidities, the use of benzodiazepines or antiepileptics, or a history of falls before hospitalization, which are risk factors for falls in hospitalized patients [2,10,15,16], nor did we evaluate the effects of postoperative hemoglobin, which conceptually could be associated with falls, although this variable has not been identified as a risk factor in major fall risk assessment studies [2,10,15,16]. Second, while perioperative care for the patients was similar, based on standardized treatment algorithms and practice standards for all patients undergoing TKA at our institution, regardless of operating surgeon, the care was not identical; therefore, again other confounding unstudied variables may account for the differences in the fall rates between the two groups.…”

“…These postoperative falls represent a major source of potential morbidity for the patient, as well as regulatory and financial liability for the institution; therefore, substantial resources have been expended to understand which patients are at risk for falling and when these falls occur [2,4,10,12,15,16]. Numerous factors associated with falls have been identified, some of which are intrinsic to the patient, such as age and cognitive impairment, while other factors are related to the procedures and treatments that they undergo, such as medication side effects and muscle weakness from peripheral nerve blocks [3,9,10,13,17].…”

“…External factors may also play a role, including room design, bed height, and staff-to-patient ratios [19,20]. Indeed, in most patients, multiple factors are likely involved [2,10,12,15,16]. In a recent study of falls in an orthopaedic unit, the type of surgery was also important, with TKA representing a particular risk [1].…”

“…reduce the likelihood that a fall will occur through implementation of fall reduction measures [2,4,10,15,16]. While considerable work has been reported to understand why patients fall, fewer studies [5-8, 11, 18, 21] have determined whether particular strategies reduce falls.…”