Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients

Hunderfund, Andrea N. Leep; Sweeney, Cynthia M.; Mandrekar, Jayawant N.; Johnson, Le Ann M.; Britton, Jeffrey W.

doi:10.4065/mcp.2010.0441

Cited by 24 publications

(24 citation statements)

References 29 publications

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“…Across all studies that reported fall rates before and after the intervention (historic and concurrent control group studies), the pooled postintervention effect (IRR) was 0.77 (95% CI = 0.52-1.12; P = .17; eight studies [14][15][16][17][18][19][20][21] ), as shown in Figure 2. There was evidence of substantial statistical heterogeneity (I 2 : 94%).…”

Section: Outcomes and Effectiveness Resultsmentioning

confidence: 99%

“…22 The large number of fall prevention studies identified that reported on U.S. acute care hospitals could provide great insight for clinicians and policy-makers on effective and less-effective strategies for reducing the risk of falls, but only a small proportion of studies reported sufficient data to evaluate the effectiveness of their approach, particularly among historical control studies. Assessing changes in the outcome of patient falls, a rare event that is subject NOTE: Weights are from random effects analysis Overall (I-squared = 94.1%, p = 0.000) Hunderfund, 2011 20 Rainville, 1984 17 Lane, 1999 21 Peterson, 2005 18 Weinberg, 2011 16 Dacenko-Grawe, 2008 15 Geffre, 2006 19 Barker,1993 14 to fluctuation, is challenging; to evaluate the effect of an intervention, the number of falls-together with the number of patients at risk or the fall rate-needs to be reported for similar study periods. 10 One study summarizing a systematic review on fall prevention published in 1998 indicated that the usefulness of published evaluations is limited because of small sample sizes, the research design used, and study quality.…”

Section: Discussionmentioning

confidence: 99%

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Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness

Hempel

Newberry

Wang

et al. 2013

J American Geriatrics Society

148

126

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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; I 2 : 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. J Am Geriatr Soc 61:483-494, 2013.Key words: fall prevention; implementation; hospital; systematic review I n-hospital falls are a significant clinical, legal, and regulatory problem, but information on effective fall reduction is lacking. The Centers for Medicare and Medicaid Services no longer reimburses hospitals for in-hospital falls with trauma.1 As the U.S. population ages, fall prevention is more relevant than ever; older, frail individuals are more prone to falls, and the consequences of falls are more severe. 2,3Preventing falls in U.S. acute care hospitals poses particular challenges, given that patients are acutely ill and average only 4.9 days in the hospital. 4 This compressed acuity places a greater burden on staff to keep patients safe, so results from fall prevention interventions in longterm care facilities may not apply to acute care settings. Similarly, resu...

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Section: Outcomes and Effectiveness Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness

Hempel

Newberry

Wang

et al. 2013

J American Geriatrics Society

148

126

View full text Add to dashboard Cite

show abstract

“…However, examination of the results of individual studies shows that the fall rate per 1000 patient-days decreased in 4 studies, 6,8,12,13 including 1 study with older patients. 13 The relative risk of falling was reduced by 23% to 29% in 2 studies.…”

Section: Resultsmentioning

confidence: 99%

Reducing Falls and Fall-Related Injuries in Acutely and Critically Ill Patients

Halm

Quigley

2011

American Journal of Critical Care

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“…Implementing EHRs has also been associated with a decline in the incidence 200 and prevalence of hospital-acquired pressure ulcers 201 , and in the incidence of falls 202,203 .…”

Section: Impact Of Ehrs On Quality and Safetymentioning

confidence: 99%