Intervention to systematize fall risk assessment and prevention in older hospitalized adults: a mixed methods study

Fall-prevention interventions are efficient but resource-requiring and should target persons at higher risk of falls. We need to ensure that fall risk is systematically assessed in everyday practice. We conducted a quality improvement (QI) intervention to systematize fall risk assessment and prevention in older adults hospitalized on general internal medicine wards. We evaluated the efficacy of the intervention in a pre-post intervention study and assessed its feasibility and acceptability through a mixed methods process evaluation, which results are reported in here.

The QI intervention was conducted between 09/2022 and 10/2023 and targeted the nursing staff and residents in two tertiary hospitals of two different language and cultural regions of Switzerland. The intervention comprised an oral presentation, an e-learning, and reminder quizzes. We conducted a process evaluation including 25 interviews and a survey sent to all participants to assess feasibility and acceptability of the intervention. Quantitative data were analyzed descriptively and qualitative data with a mixed deductive and inductive approach. Results were integrated through meta-inferences.

Among 544 clinicians, 59% completed the e-learning, 74% found the intervention useful, and 25% reported an increase in interprofessional team working. A rewarding system was deemed motivating by 33% of clinicians. Main implementation barrier was the high workload. A concise and clear content as well as regular reminders were perceived as facilitators.

A concise and multimodal QI intervention with regular reminders seemed to be feasible and well-accepted. Future QI intervention projects should consider the barriers and facilitators identified in this project to improve quality of care in older hospitalized adults.

The conducted research was not pre-registered.