title: Shifting the paradigm: an assessment of the quality of fall risk reduction in Nebraska hospitals.
abstract: OBJECTIVE
  To assess the prevalence of evidence-based fall risk reduction structures and processes in Nebraska hospitals; whether fall rates are associated with specific structures and processes; and whether fall risk reduction structures, processes, and outcomes vary by hospital type--Critical Access Hospital (CAH) versus non-CAH.
  
  
  METHODS
  A cross-sectional survey of Nebraska's 83 general community hospitals, 78% of which are CAHs. We used a negative binomial rate model to estimate fall rates while adjusting for hospital volume (patient days) and the exact Pearson chi-square test to determine associations between hospital type and the structure and process of fall risk reduction.
  
  
  RESULTS
  Approximately two-thirds or more of 70 hospitals used 6 of 9 evidence-based universal fall risk reduction interventions; 50% or more used 14 of 16 evidence-based targeted interventions. After adjusting for hospital volume, hospitals in which teams integrated evidence from multiple disciplines and reflected upon data and modified polices/procedures based upon data had significantly lower total and injurious fall rates per 1,000 patient days than hospitals that did not. Non-CAHs were significantly more likely than CAHs to perform 5 organizational-level fall risk reduction processes. CAHs reported significantly greater total (5.9 vs 4.0) and injurious (1.7 vs 0.9) fall rates per 1,000 patient days than did non-CAHs.
  
  
  CONCLUSIONS
  Hospital type was a significant predictor of fall rates. However, shifting the paradigm for fall risk reduction from a nursing-centric approach to one in which teams implement evidence-based practices and learn from data may decrease fall risk regardless of hospital type.
authors.affiliation: Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Jones
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Venema
authors.forename: Regina
authors.initials: R
authors.lastname: Nailon
authors.forename: Anne M
authors.initials: AM
authors.lastname: Skinner
authors.forename: Robin
authors.initials: R
authors.lastname: High
authors.forename: Victoria
authors.initials: V
authors.lastname: Kennel
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D006278:Medicare; D009329:Nebraska; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D040242:Risk Reduction Behavior; D014481:United States
keywords: Critical Access Hospitals; organizational learning; patient falls; quality; teamwork