Fall prevention strategies under scrutiny

How about this for a bold statement: Patient falls in hospital settings should not be considered preventable. That’s the conclusion of a recent literature review performed by a duo of researchers from The University of Texas Medical School at Houston and published in the Journal of the American Academy of Orthopaedic Surgeons.

The researchers essentially took issue with the financial burdens placed on hospitals when a patient’s fall could have been prevented following evidence-based guidelines. After reviewing studies of programs meant to prevent falls in the elderly, researchers said that “the risk of fall is only slightly greater in the hospital environment than in the home and that there is no medical evidence that evidence-based guidelines are effective in fall prevention.”

Orthopaedic surgeon Terry A. Clyburn, MD, who co-authored the literature review, said hospitals should certainly educate patients on fall prevention and employ common sense tactics like using bed rails and keeping floors dry and clear of clutter.

“But we found no proof that falls in hospital are, in fact, preventable,” Clyburn said. “And if not, they should not be categorized as a preventable occurrence and the burden shouldn't be borne by hospitals.”

The researchers did point out that comprehensive fall prevention programs that include patient education, vision assessments and walking aids are more effective in long-term care or carefully managed home care settings than in hospitals, with length of stay being a primary factor. Because hospital patients are receiving care for other important conditions—conditions that may require general anesthesia or strong pain medication during patients’ “typical” short stays in the setting—managing all of the risk factors that contribute to falls just isn’t feasible.

Long-term strategies, however, which focus on strength training, balance and functional performance, are the most effective at preventing falls. And those of course are delivered better in the LTC environment when the length of stay can be 30 days or more.

While the literature review poses good questions, I don’t see how hospitals could ever be given a free pass on preventable falls—even if “preventable falls” don’t exist in hospitals, as the researchers argued. Perhaps current prevention programs just haven’t hit their stride. Hopefully, this and other studies will further the continued evolution of effective fall prevention strategies. And may that evolution outpace the financial “incentives” that demand success.

Topics: Clinical