The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review

Abstract

Objectives:The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms.Methods: An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews.Results: After a multitiered process, 30 articles met the selection criteria.Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail.Conclusions: Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

“…The built environment is a core aspect of patient safety, falls risk, 8,20 and potentially also may influence positively or negatively the need for bed moves. Changes to ward layout or practice that can accommodate increased visibility for patients with high falls risk, for example, through decentralized nursing or portable nursing stations, 36 may reduce risk of falls, and the need for bed moves.…”

“…A recent integrative review highlighted the importance of the built environment in hospitals as a contributor to falls risk, but that there is limited research quantity and quality to adequately inform healthcare design decision-making. 20 Further research needs to focus on design elements for hospital room and wards that can be implemented to achieve improved organisational, staff and patient outcomes, 8 including reduced falls and reduced bed moves.…”

“…12,15 System or organisational factors other than bed moves that may also impact on individual patient care and safety include the person-centredness of care, 16 level of inter-professional collaboration, 17 and the safety of the ward environment. [18][19][20][21] While there has been growing research in recent years evaluating bed moves, ward safety, and nature of care (including person-centredness), these have rarely been investigated in the one study, despite their potential interaction. This study was undertaken due to the strong association of falls with recurrent falls risk and the high personal and health system costs of falls in hospitals.…”

Sağlık Yapılarında Kanıta Dayalı Tasarım

“…Copeland and Chambers (2017) found that the presence of handrails and non-slippery floor covering contributed to a 55% reduction in patient falls [77]. Pati et al (2021) found that the toilet seat on the side wall instead of directly opposite the bathroom entrance is a factor reducing falls [78]. Bosia et al (2016) suggested that oncology and internal medicine departments care about patients and their relatives, their mobility, the ability to move around the room, and easy access to the bathroom.…”

Hierarchy of Evidence: An Appraisal Tool for Weighting the Evidence in Healthcare Design Research Based on Internal Validity

“…Although these appraisal tools have been instrumental in evaluating studies involving systematic literature reviews in the field of healthcare design research (e.g., Pati et al, 2019; Weerasuriya et al, 2019), they have shortcomings that needs to be addressed to render more effective and meaningful appraisal of published studies in the domain of healthcare design research. These shortcomings are discussed in the following sections.…”