A systematic review of the measurement of falls in hospitals

Abstract Background In-patient falls are a major cause of morbidity and mortality in the United Kingdom (UK) National Health Service (NHS). Although falls prevention guidelines exist, there is little evidence supporting the efficacy of interventions in hospital settings. Current national benchmarking based on occupied bed days (OBD) does not acknowledge varying ward layouts, differences in patient visibility, and staffing levels, which affect the ability to monitor at-risk patients. This leads to benchmarking and performance reporting that is not an accurate reflection of the challenges faced which suggests the measurement may not be a useful comparator. This systematic review seeks to evaluate the use and limitations of the measurement of accidental falls in hospital, when considered in the context of the setting in which reported. Methods This review was conducted to PRISMA guidelines for systematic reviews. Interventional studies that used falls/1000 OBD as a metric were included. Thematic analysis within NVivo15® was utilised to analyse extracted narrative data, author reported limitations and contextual variables. The Systems Engineering Initiative for Patient Safety (SEIPS) model was used to theme, interpret and present the results. Results From 3,541 articles searching 9 databases, 103 studies from 19 countries were included. The study has four key findings. The definition of a fall varies between study sites and is not stated in 42 (50%) of the full text studies. There is a lack of consistency in how the measure is expressed, resulting in comparison between hospitals that is not equivalent. The type of fall or how it is classified may mean that not all falls are reported due to subjectivity at ward level. There are multiple different interpretations of what constitutes a fall. There are multiple contextual challenges that cause substantial variability; such as ward design and patient visibility, that are not measured. Staff available on each shift has also not been measured as a variable. Conclusion The findings from this study emphasise the importance of understanding how hospital falls are shaped by interactions between technology, people, and the environment. This reinforces the need for a systems perspective and Human Factors methodologies to tackle this pervasive patient safety challenge.