Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness

In-hospital falls are a significant clinical, legal, and regulatory problem, but information on effective fall reduction is lacking. The Centers for Medicare and Medicaid Services no longer reimburses hospitals for in-hospital falls with trauma.1 As the U.S. population ages, fall prevention is more relevant than ever; older, frail individuals are more prone to falls, and the consequences of falls are more severe.2,3 Preventing falls in U.S. acute care hospitals poses particular challenges, given that patients are acutely ill and average only 4.9 days in the hospital.4 This compressed acuity places a greater burden on staff to keep patients safe, so results from fall prevention interventions in long-term care facilities may not apply to acute care settings. Similarly, results from the international literature, where hospital stays are longer, may not generalize to U.S. hospitals. Fall prevention programs are typically complex, involving multiple components that depend on leadership involvement and the cooperation of frontline staff from multiple disciplines. Programs may require potent monitoring strategies to ensure that staff adhere to implemented care protocols. Recent reviews provide limited evidence for acute care settings.3,5–7 It was hypothesized that the confluence of an effective strategy to implement interventions into clinical practice in acute care settings, the intervention components chosen, the type of monitoring strategies used to ensure adherence, and the baseline level of care intensity provided in the comparison group would determine a fall prevention program's success. A systematic review was performed documenting implementation strategies, intervention components and comparators, adherence information, and the effectiveness of published fall prevention approaches in U.S. acute care hospitals.