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Review of programs to reduce in-hospital falls in U.S. acute care hospitals shows that some programs are beneficial but reporting is poor

Hempel S, Newberry S, et al. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. J Am Geriatr Soc. 2013;61:483-94.

Review question

What are falls prevention programs in U.S. acute care hospitals like?

Background

In-hospital falls are an important problem. But information on effective fall reduction is lacking.

As the population ages, fall prevention is more relevant than ever. Older and frailer people are more prone to falls. And the consequences of their falls are more severe.

Fall prevention programs usually depend on leadership involvement and frontline staff cooperation. They may also require powerful monitoring plans to ensure staff compliance with care procedures.

How the review was done

This summary is based on a systematic review of 59 studies. 4 randomized controlled trials (or RCTs); 7 studies reporting on an intervention and a nonrandomized control group; and 48 studies comparing falls numbers or fall rates with those from the period before the start of the program.

The review looked at program effectiveness, implementation, components, comparisons, and compliance.

These studies appeared in U.S. journals over a period of 28 years. 39 studies targeted selected wards or units. 16 evaluated changes in an entire hospital. 4 assessed more than one hospital. The number of patients included ranged from fewer than 50 to more than 10,000 per study.

What the researchers found

In terms of effectiveness, most reported positive changes. But only 45% of studies with a control group reported sufficient data to compare fall rates. And only 15% of studies comparing falls with those from the period before the start of the program did the same.

Studies did not describe implementation strategies well. 17% did not document them at all. Reported strategies were staff education, creating committees, seeking leadership support, and occasionally continuous quality improvement techniques.

Most fall prevention programs (81%) had multiple components. They included risk assessments, visual risk alerts, patient education, care rounds, bed-exit alarms, and post-fall evaluations. 54% of the programs did not report on fall prevention measures used in the comparison group.

39% did not report data on accuracy of practice or describe compliance strategies (such as regular audits and feedback to ensure completion of care processes).

Conclusion

Some programs to reduce in-hospital patient falls in U.S. acute care hospitals are beneficial.

Fall prevention programs in U.S. acute care hospitals