Falls during Acute Hospital Stays - Article Example

The relative risk estimate of 0.29 (95% CI: 0.1–0.87) favors the intervention group. In conclusion, the study showed that targeted multiple interventions were effective in reducing the incidences of falls in patients in the acute care setting.

Does using a fall risk screening tool lead to a reduction in falls during acute hospital stays?

Design

A randomized prospective design was implemented at one acute care hospital in Singapore between April 2005 and December 2006. They compared the effectiveness of two interventions (targeted multiple interventions with usual care versus usual care only) on patients identified as high-risk for falls over 8 months.

Participants

Newly admitted patients from medical, surgical, oncology, orthopedic, and gynecology wards participated. Inclusion criteria were the age of 18 years or older, and agreement to participate in the study. Patients were excluded if they were in the study wards before the start of the study, or if they had fallen before the fall-risk assessment was carried out.

Validity and reliability

The study used a falls assessment tool to identify patients at risk for falls. Those who had scores of 5 and above using the Hendrich II Fall Risk Model were recruited into the study. The Hendrich II Fall Risk Model used in this study had been validated on 5489 patients in this setting (Ang et al. 2007). The study showed that the Hendrich II Fall Risk Model showed the best balance of sensitivity (70%, 95% CI: 57.5–80.1) and specificity (61.5%, 95% CI: 60.2–62.8). The accuracy of the Hendrich II Fall Risk Model at the published cut-off point, measured using Area Under the Curve (AUC), was 73%. The researchers used the incidence of falls as a measurement of the outcome in this study. Patients’ occurrence falls information was retrieved from the entries made by the ward nurses into the hospital eHOR system. On top of these, it is the research nurses that screened and enrolled the patient in the study. The ward nurses were not aware of which patient was recruited into the study, nor were they informed about the study methodology, including the interventions received by the participants in both the control and intervention groups. Thus, the ward nurses, who recorded the patients’ outcomes of falls incidences, were not aware of the patients’ involvement in the study.

Data collection

The nurses reviewed the medical records of all the participants to gather information about their medical history and treatment and documented the demographic data on a data collection form. Both the participants in the intervention and control groups were followed up until the time of their first fall, discharge from the hospital, or death, whichever occurred first. The investigator also scanned the electronic hospital occurrence report (eHOR) daily weekday for entries of fall incidences reported by the nurses from the wards and ascertained if the entries were on participants involved in the study. The investigator obtained information on the circumstances surrounding the participant’s fall based on the eHOR report and participant’s medical records and nurses’ and participant’s accounts of the incident as necessary. The information was entered into the fall data collection form.

Data analysis

Analysis of the data was done using SPSS (SPSS Inc., Chicago, IL, USA) version 14.0. All statistical analyses were carried out on an intention-to-treat basis. The researcher reported the incidence rates of falls during a hospital stay in the intervention and control groups with 95% Confidence Intervals calculated using the Wilson method (Wilson 1927) and compared using the Chi-square test. The 95% Confidence Interval and the relative risk were estimated calculated using the methods described by Armitage and Berry (1994). The time from randomization to the first fall of the participants in the two groups was also calculated in days. The time to event curves was constructed using the Kaplan–Meier method and the comparisons between the two groups were made using the log-rank test.

Results

A total of 1822 patients participated in the study with 912 and 910 participants in the control and intervention groups, respectively. The fall incidence rates were estimated to be 1.5% (95% CI: 0.9–2.6) and 0.4% (95% CI: 0.2–1.1) in the control and intervention groups, respectively. Finally, the relative risk estimate of 0.29 (95% CI: 0.1–0.87) favors the intervention group.

Conclusion

Based on the above procedures, it is evident that the study was free from bias and that the results of the study can be relied on. The research employed single blinding and as such the patient nurses could not in any way manipulate the study in any manner. The research design was well articulated. In addition, the analysis of data was also up to the standard.