Using human factors and ergonomics principles to prevent inpatient falls

Inpatient falls are frequently reported incidents in hospitals around the world. The recent COVID-19 pandemic has further exacerbated the risk. With the rising importance of human factors and ergonomics (HF&E), a fall prevention programme was introduced by applying HF&E principles to reduce inpatient falls from a systems engineering perspective. The programme was conducted in an acute public hospital with around 750 inpatient beds in Hong Kong. A hospital falls review team (the team) was formed in June 2020 to plan and implement the programme. The 'Define, Measure, Analyse, Improve and Control' (DMAIC) method was adopted. Improvement actions following each fall review were implemented. Fall rates in the 'pre-COVID-19' period (January-December 2019), 'COVID-19' period (January-June 2020) and 'programme' period (July 2020-August 2021) were used for evaluation of the programme effectiveness. A total of 120, 85 and 142 inpatient falls in the 'pre-COVID-19', 'COVID-19' and 'programme' periods were reviewed, respectively. Thirteen areas with fall risks were identified by the team where improvement actions applying HF&E principles were implemented accordingly. The average fall rates were 0.476, 0.773 and 0.547 per 1000 patient bed days in these periods, respectively. The average fall rates were found to be significantly increased from the pre-COVID-19 to COVID-19 periods (mean difference=0.297 (95% CI 0.068 to 0.526), p=0.009), which demonstrated that the COVID-19 pandemic might have affected the hospitals fall rates, while a significant decrease was noted between the COVID-19 and programme periods (mean difference=-0.226 (95% CI -0.449 to -0.003), p=0.047), which proved that the programme in apply HF&E principles to prevent falls was effective. Since HF&E principles are universal, the programme can be generalised to other healthcare institutes, which the participation of staff trained in HF&E in the quality improvement team is vital to its success.