Fall prevention in acute care hospitals: a randomized trial.
BACKGROUND
Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls.


OBJECTIVE
To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals.


METHODS
Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).


METHODS
The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients' specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders.


METHODS
The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.


RESULTS
During the 6-month intervention period, the number of patients with falls differed between control (n = 87) and intervention (n = 67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P = .04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P = .003). No significant effect was noted in fall-related injuries.


CONCLUSIONS
The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.


BACKGROUND
clinicaltrials.gov Identifier: NCT00675935.
Brigham and Women's Hospital/Partners HealthCare System, Harvard Medical School, Boston, MA, USA. pdykes@partners.org
Patricia C
PC
Dykes
Diane L
DL
Carroll
Ann
A
Hurley
Stuart
S
Lipsitz
Angela
A
Benoit
Frank
F
Chang
Seth
S
Meltzer
Ruslana
R
Tsurikova
Lyubov
L
Zuyov
Blackford
B
Middleton
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D003142:Communication; D005260:Female; D006751:Hospital Information Systems; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018570:Risk Assessment; D012984:Software; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000517:prevention & control