Meg E Morris1,2, Terry Haines3, Anne Marie Hill4, Ian D Cameron5, Cathy Jones6, Dana Jazayeri1,2, Biswadev Mitra7, Debra Kiegaldie8,9, Ronald I Shorr10, Steven M McPhail11,12. 1. Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia. 2. La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia. 3. School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia. 4. School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. 5. John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St. Leonards, New South Wales, Australia. 6. Healthscope, Melbourne, Victoria, Australia. 7. School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 8. Holmesglen Institute, Melbourne, Victoria, Australia. 9. Eastern Clinical School, Monash University, Melbourne, Australia. 10. Geriatric Research Education and Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA and Department of Epidemiology, University of Florida, Gainesville, Florida, USA. 11. Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia. 12. Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia.
Abstract
BACKGROUND/ OBJECTIVES: We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. DESIGN: Two-group, multi-site cluster-randomized active-control non-inferiority trial. SETTING: Hospital wards. PARTICIPANTS: Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). INTERVENTION: Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. MEASUREMENTS: The primary measure was between-group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. RESULTS: The experimental clinical reasoning approach was non-inferior to the usual care FRAT that assigned fall risk ratings when compared to a-priori stakeholder derived and sensitivity non-inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. CONCLUSION: Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
RCT Entities:
BACKGROUND/ OBJECTIVES: We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. DESIGN: Two-group, multi-site cluster-randomized active-control non-inferiority trial. SETTING: Hospital wards. PARTICIPANTS: Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). INTERVENTION: Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. MEASUREMENTS: The primary measure was between-group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. RESULTS: The experimental clinical reasoning approach was non-inferior to the usual care FRAT that assigned fall risk ratings when compared to a-priori stakeholder derived and sensitivity non-inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. CONCLUSION: Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
Authors: Meg E Morris; Kate Webster; Cathy Jones; Anne-Marie Hill; Terry Haines; Steven McPhail; Debra Kiegaldie; Susan Slade; Dana Jazayeri; Hazel Heng; Ronald Shorr; Leeanne Carey; Anna Barker; Ian Cameron Journal: Age Ageing Date: 2022-05-01 Impact factor: 12.782
Authors: Hazel Heng; Debra Kiegaldie; Susan C Slade; Dana Jazayeri; Louise Shaw; Matthew Knight; Cathy Jones; Anne-Marie Hill; Meg E Morris Journal: PLoS One Date: 2022-04-27 Impact factor: 3.752