A Stepped-Wedge Cluster-Randomized Controlled Trial of a Multi-interventional Approach for Fall Prevention

Area of Science:

• Gerontology and Geriatric Medicine
• Patient Safety and Quality Improvement
• Health Services Research

Background:

• Hospital falls are a common adverse event, leading to injuries, increased length of stay (LOS), and higher costs.
• Effective strategies are needed to mitigate fall risks and associated negative patient outcomes in healthcare settings.

Purpose of the Study:

• To evaluate the effectiveness of a comprehensive, multi-interventional approach in reducing inpatient fall rates and fall-related injuries.
• To assess the impact of these interventions on patient length of stay (LOS).

Main Methods:

• A 36-week stepped-wedge cluster-randomized controlled trial was conducted across 18 units in a public university hospital.
• Interventions included staff training, patient education, enhanced environmental safety (lighting, call bells, signage), improved patient monitoring, and optimized mobility assistance.
• The primary outcome was falls per 1000 patient-days; secondary outcomes included fall-related injuries and LOS.

Main Results:

• A significant reduction in fall rates was observed, decreasing from 4 to 1.34 falls per 1000 patient-days (Incidence Rate Ratio [IRR] = 0.19, P = .001).
• Fall-related injuries also decreased significantly, from 2.4 to 0.79 per 1000 patient-days (IRR = 0.22, P = .001).
• No statistically significant difference was found in the length of stay (LOS) between intervention and control periods.

Conclusions:

• The implemented multi-interventional strategy effectively reduced inpatient falls and injuries.
• The study did not demonstrate an overall impact on patient length of stay (LOS).
• Further research is warranted to explore the long-term sustainability and impact of these fall prevention strategies.