title: Outpatient falls prevention program outcome: an increase, a plateau, and a decrease in incident reports.
abstract: OBJECTIVE
  We implemented an outpatient falls guideline in 2008 in the department of radiology. Here, we describe our multiyear experience.
  
  
  METHODS
  This was a retrospective study conducted between April 2006 and September 2013 to investigate outpatient falls. The span of the study was divided into eight periods. The incident reporting system was searched for the falls and the fall-related variables.
  
  
  RESULTS
  A total of 327 falls occurred during 5,080,512 radiology examinations (rate, 0.64/10,000 total examinations). The highest rate was in period 6 (0.83/10,000 examinations). The average for periods 1 and 2 is 0.39/10,000 examinations (37 falls/945,427 examinations), and the average for periods 3-6 is 0.77/10,000 examinations (204 falls/2,656,805 examinations). The average rate for periods 7 and 8 is 0.58/10,000 examinations (86 falls/1,478,280 examinations). There was a statistically significant increase in the total number of falls reported between period 2 and period 3 (p = 0.02). There was a statistically significant decrease in outpatient falls between period 6 and period 7 (p = 0.01). The number of falls among patients 60 years old or older was 177 falls/2,180,093 examinations (rate, 0.81/10,000 examinations), and that among patients younger than 60 years was 150 falls/2,900,419 examinations (rate, 0.52/10,000 examinations), with a statistically significant difference (p = 0.007). Although the rate of falls was higher among female patients, there was no statistically significant difference between the sexes (p = 0.18).
  
  
  CONCLUSIONS
  The outcome of the outpatient falls guideline was characterized by an increase, a plateau, and a decrease in incident reports. The initial increase may be due to the Hawthorne effect. The plateau may represent the value closest to the true incidence. The decrease may represent the effect of the program.
authors.affiliation: 1 All authors: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders Bldg, Rm 210, Boston, MA 02114.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Abujudeh
authors.forename: Shima
authors.initials: S
authors.lastname: Aran
authors.forename: Laleh
authors.initials: L
authors.lastname: Daftari Besheli
authors.forename: Karen
authors.initials: K
authors.lastname: Miguel
authors.forename: Elkan
authors.initials: E
authors.lastname: Halpern
authors.forename: James H
authors.initials: JH
authors.lastname: Thrall
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D012307:Risk Factors; D012308:Risk Management / Q000706:statistics & numerical data; D017678:Sex Distribution; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
keywords: falls; incident reports; process quality improvement; quality; quality improvement program; risk reduction