Author Affiliations: Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Najafpour); School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Drs Arab and Rashidian); University of Luxembourg, Luxembourg (Dr Shayanfard); Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Yaseri); and Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Biparva-Haghighi).
Qual Manag Health Care. 2024;33(2):77-85. doi: 10.1097/QMH.0000000000000435. Epub 2023 Nov 30.
Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries.
The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS.
The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P = .52).
This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.
跌倒在医院是最常见的不良事件之一，可能导致受伤甚至死亡。它还与住院时间（LOS）和住院费用的增加有关。本实验旨在研究多种干预措施对降低住院患者跌倒率和随之而来的伤害的有效性。
本研究为一个阶梯式楔形集群随机对照试验。在一家公立医院的 18 个病房进行了 36 周。本研究纳入了有跌倒风险的患者。共有 33856 名患者入院，其中 4766 名被认为是高危患者。在干预阶段，考虑了一系列预防和控制措施，包括员工培训；患者教育；放置护理呼叫铃；充足的照明；在转运和交接过程中对高危患者进行监督；移动设备分配；在浴室放置呼叫铃和安全防护装置；在患者病床上方放置“跌倒警报”标志；护士及时向医生报告并发症，如谵妄和缺氧；鼓励适当使用眼镜、助听器和鞋子；保持侧轨抬起；每次跌倒后重新评估患者。主要结果是每 1000 名患者-天的参与者跌倒次数。次要结果是跌倒相关伤害和 LOS。
结果显示，跌倒率下降（n = 4 每 1000 名患者-天与 1.34 每 1000 名患者-天，发病率比（IRR）= 0.19 [95%置信区间（CI），0.14-0.26]；P =.001）和伤害（n = 2.4 每 1000 名患者-天与 0.79 每 1000 名患者-天，IRR = 0.22 [95% CI，0.15-0.32]；P =.001）在暴露组与未暴露组之间。 LOS 无显著差异（暴露组平均 10.63 天[95%CI，10.26-10.97]，未暴露组平均 10.84 天[95%CI，10.59-11.09]，平均差异=-0.13 [95%CI，-0.53 至 0.27]，P =.52）。
这项多干预试验显示，跌倒和跌倒率的减少与伤害有关，但对 LOS 没有总体影响。需要进一步研究以了解医院中多种跌倒预防策略的可持续性及其长期影响。
