A pre-post intervention study to improve fall risk assessment in older hospitalised adults: the STROLL study

Approximately 25–30% of individuals aged ≥ 65 years fall yearly. A history of falls is a major and easy to assess risk factor predicting future falls. As systematic assessment is often lacking, we developed an interprofessional quality improvement (QI) intervention, based on this major risk factor, to improve documentation of falls history in older adults hospitalised on general internal medicine wards and tested its impact in a pre-post intervention study. This pre-post intervention study was conducted on all general internal medicine wards of two Swiss university (tertiary) hospitals from 08/2022 to 11/2023 and included a four-month observational pre-intervention, a nine-month intervention, and a three-month observational post-intervention period. The intervention was provided to residents and nurses and included an e-learning session, an oral presentation, and for nurses, monthly reminders using quizzes. Its effect was assessed among all patients aged ≥ 65 years. We used logistic regression to assess the association between the intervention period and documented falls history and, among those who had a documented falls history, compared the occurrence of patient-related outcomes (prescription of in-hospital physiotherapy, discharge to rehabilitation, emergency room visit or readmission after three months) between patients who did vs. who did not have a fall in the last 12 months. The intervention’s effect was assessed among 6864 patients (mean age 79.2 [± 7.9] years, 45.7% female). The odds of a documented falls history was lower during the pre-intervention than during the intervention period (OR 0.56, 95% confidence interval [CI] 0.50–0.63), while there was no significant difference between the post-intervention and the intervention period (OR 1.11, 95% CI 0.97–1.26). Among patients who had a documented falls history, the prescription of physiotherapy (83% vs. 70%, p < 0.001) and discharge to a rehabilitation centre (12% vs. 9%, p < 0.02) were higher in patients who suffered from a fall within the last 12 months vs. those who did not. The QI intervention was successful in increasing the documentation of falls history. This intervention, which can easily be implemented in everyday clinical practice, is an important step to help improve care of patients at higher risk of falling.