Anne-Marie Hill1, Steven M McPhail2, Nicholas Waldron3, Christopher Etherton-Beer4, Katharine Ingram5, Leon Flicker4, Max Bulsara6, Terry P Haines7. 1. School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Western Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Western Australia. Electronic address: anne-marie.hill@nd.edu.au. 2. Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia. 3. Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, WA, Australia; Health Strategy and Networks, Strategic System, Policy and Planning, Department of Health, Government of Western Australia, Perth, WA, Australia. 4. School of Medicine and Pharmacology, WA Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia; Royal Perth Hospital, Department of Health, Government of Western Australia, Perth, WA, Australia. 5. Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Department of Health, Government of Western Australia, East Perth, WA, Australia. 6. Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Western Australia. 7. Physiotherapy Department, Monash University, Frankston, VIC, Australia; Allied Health Research Unit, Monash Health, Clayton, VIC, Australia.
Abstract
BACKGROUND: Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. METHODS: Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). FINDINGS:Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42-0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42-0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7-19], control 10 days [6-18]). INTERPRETATION:Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units. FUNDING: State Health Research Advisory Council, Department of Health, Government of Western Australia.
RCT Entities:
BACKGROUND: Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. METHODS: Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). FINDINGS: Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42-0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42-0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7-19], control 10 days [6-18]). INTERPRETATION: Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units. FUNDING: State Health Research Advisory Council, Department of Health, Government of Western Australia.
Authors: Anne-Marie Hill; Angela Jacques; A Michelle Chandler; Phyllis A Richey; Lorraine C Mion; Ronald I Shorr Journal: Jt Comm J Qual Patient Saf Date: 2018-09-28
Authors: Jacqueline Francis-Coad; Anne-Marie Hill; Angela Jacques; A Michelle Chandler; Phyllis A Richey; Lorraine C Mion; Ronald I Shorr Journal: J Gerontol A Biol Sci Med Sci Date: 2020-09-25 Impact factor: 6.053
Authors: Anne-Marie Hill; Steven M McPhail; Terry P Haines; Meg E Morris; Christopher Etherton-Beer; Ronald Shorr; Leon Flicker; Max Bulsara; Nicholas Waldron; Den-Ching A Lee; Jacqueline Francis-Coad; Amanda Boudville Journal: J Gerontol A Biol Sci Med Sci Date: 2019-08-16 Impact factor: 6.053
Authors: Kea Turner; Vincent Staggs; Catima Potter; Emily Cramer; Ronald Shorr; Lorraine C Mion Journal: BMJ Qual Saf Date: 2020-03-18 Impact factor: 7.035
Authors: Kea Turner; Vincent S Staggs; Catima Potter; Emily Cramer; Ronald I Shorr; Lorraine C Mion Journal: J Patient Saf Date: 2022-01-01 Impact factor: 2.844