title: Developing a multi-systemic fall prevention model, incorporating the physical environment, the care process and technology: a systematic review.
abstract: OBJECTIVE
  This paper reports a review that assessed the effectiveness and characteristics of fall prevention interventions implemented in hospitals. A multi-systemic fall prevention model that establishes a practical framework was developed from the evidence.
  
  
  BACKGROUND
  Falls occur through complex interactions between patient-related and environmental risk factors, suggesting a need for multifaceted fall prevention approaches that address both factors.
  
  
  METHODS
  We searched Medline, CINAHL, PsycInfo and the Web of Science databases for references published between January 1990 and June 2009 and scrutinized secondary references from acquired papers.
  
  
  METHODS
  Due to the heterogeneity of interventions and populations, we conducted a quantitative systematic review without a meta-analysis and used a narrative summary to report findings.
  
  
  RESULTS
  From the review, three distinct characteristics of fall prevention interventions emerged: (1) the physical environment, (2) the care process and culture and (3) technology. While clinically significant evidence shows the efficacy of environment-related interventions in reducing falls and fall-related injuries, the literature identified few hospitals that had introduced environment-related interventions in their multifaceted fall intervention strategies.
  
  
  CONCLUSIONS
  Using the multi-systemic fall prevention model, hospitals should promote a practical strategy that benefits from the collective effects of the physical environment, the care process and culture and technology to prevent falls and fall-related injuries. By doing so, they can more effectively address the various risk factors for falling and therefore, prevent falls. Studies that test the proposed model need to be conducted to establish the efficacy of the model in practice.
authors.affiliation: College of Architecture, Georgia Institute of Technology, Atlanta, Georgia, USA. ys.choi@gatech.edu
authors.forename: Young-Seon
authors.initials: YS
authors.lastname: Choi
authors.forename: Erin
authors.initials: E
authors.lastname: Lawler
authors.forename: Clayton A
authors.initials: CA
authors.lastname: Boenecke
authors.forename: Edward R
authors.initials: ER
authors.lastname: Ponatoski
authors.forename: Craig M
authors.initials: CM
authors.lastname: Zimring
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D004779:Environment Design / Q000592:standards; D006272:Health Facility Environment / Q000592:standards*; D006761:Hospitals; D006801:Humans; D015279:Organizational Culture; D010346:Patient Care Management / Q000458:organization & administration*; D061214:Patient Safety / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017751:Safety Management / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000517:prevention & control