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Selected Works of Max Bulsara
Article
Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial
Lancet (2015)
  • Anne-Marie Hill, The University of Notre Dame Australia
  • Steven McPhail, Queensland University of Technology
  • Nicholas Waldron, Government of Western Australia, Department of Health
  • Christopher Etherton-Beer, University of Western Australia
  • Katherine Ingram, Sir Charles Gairdner Hospital
  • Leon Flicker, University of Western Australia
  • Max Bulsara, The University of Notre Dame Australia
  • Terry Haines, Monash University
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Abstract
Background: Falls are the most frequent adverse events that are reported in hospitals. We examined the eff ectiveness
of individualised falls-prevention education for patients, supported by training and feedback for staff , delivered as a
ward-level programme.
Methods: Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge,
cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or
control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit
during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised
education that was based on principles of changes in health behaviour from a trained health professional, in addition
to usual care. We provided information about patients’ goals, feedback about the ward environment, and perceived
barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by
patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of
patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New
Zealand Clinical Trials registry, number ACTRN12612000877886).
Findings Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period;
n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days,
adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131,
4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%]
adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group.
There was no signifi cant diff erence in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]).
Interpretation: Individualised patient education programmes combined with training and feedback to staff added to
usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.
Disciplines
Publication Date
2015
DOI
10.1016/S0140-6736(14)61945-0
Citation Information
Hill, A., McPhail, S., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara, M., and Haines, T. (2015). Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet, 385(9987), 2592-2599. DOI: 10.1016/S0140-6736(14)61945-0