Do nursing stations within bays of hospital wards reduce the rate of inpatient falls ? – An Interrupted Time Series Analysis from the United Kingdom
Ali U., Judge A., Foster C., Brooke A., Davis L., James K., Marriott T., Lamb S.
Objectives: Falls are a major public health burden for individuals and society. They are associated with loss of independence, functional decline and are a contributing reason for subsequent admission to long-term care. The financial burden associated with injurious falls is substantial. This study aims to evaluate whether the introduction of portable nursing stations within bays of hospital wards led to a change in the rate of inpatient falls. Methods: Data on inpatient falls from local hospital incident reporting software (Datix) were collected monthly between April 2014 and March 2017 across 17 wards within two UK hospitals (Stoke Mandeville & Wycombe General). The outcome was the monthly rate of falls per 1000 occupied bed days (OBDs). Using a natural experimental study design and interrupted time series analysis we assessed whether trends in fall rates changed following the introduction of portable nursing stations in April 2016. Results: A total of 2322 falls were reported during the study period, and 59% (1344/2276) occurred in men. The overall median age of fallers was 81. 99.3% of falls (2306/2322) were classified as either none, low or moderate harm with 0.5% (12/2322) resulting in severe harm and less than 0.2% (4/2322) resulting in death. Up to April 2016, the monthly rate of falls were increasing by 0.127 per 1000 OBDs [p=0.002 95% CI (0.051, 0.204)]. After the intervention was introduced, the monthly rate of falls was decreasing by 0.437 per 1000 OBDs [p=0.003 95% CI (-0.710, -0.163)]. At 12 months post-intervention, the absolute difference in the rate of falls between the estimated post-intervention trend and the pre-intervention projected estimate was 4.59 falls per 1000 OBDs. This was a relative percentage reduction of 46.3%. Conclusion: This study provides evidence that the introduction of portable nursing stations was temporally associated with a reduction in the monthly rate of falls. This intervention has the potential to be applied across the NHS and may reduce the number of inpatient falls.