Preventing Hospital Falls: Optimal Screening

INTERVENTION: For the experimental group hospitals, we shall replace the old Falls Risk Assessment Tool (called FRATA) with a new form (called FRATB) that does not assign a score to falls risk screening yet includes the other elements. The "intervention" is filling in the FRAT forms and will be done within 24 hours after a patient is admitted and then repeated during the hospital stay if the falls risk changes. The FRAT takes approximately 5‐10 minutes for nurses and health professionals to fill in. For the intervention, the actual risk screening assessment form used by healthcare professionals shall contain information needed to assign ratings. The procedure will be for the registered nurses and other registered health professionals to fill in the risk screening assessment at the patient admission and then repeat filling in the form if the patient status changes. They will do this by meeting with the individual hospital patients, reading the history and making an informed decision about risk. The location where the intervention occurs will always be an Australian hospital or rehabilitation facility. An independent data monitoring committee will monitor falls in the included hospitals. An independent assessor will monitor fidelity by cross checking at least 20% of the medical histories for the people found to fall. CONDITION: Falls; ; Falls Public Health ‐ Health service research PRIMARY OUTCOME: The primary outcome measure will be fall rates (per 1000 bed days), derived from the hospital “Riskmanâ€? incident management system. [June 2019] SECONDARY OUTCOME: (i) estimated FRAT /clinician judgement form documentation completions using compliance audits in intervention and control hospitals. Assessments will be done of at least 100 patient histories from each hospital site to check that clinicians have completed the correct form and the extent to which they complete them correctly. This outcome is assessed with a study‐specific questionnaire.[June 2019] (ii) Estimated difference in time taken to complete traditional FRAT and new screening forms. At least 30 clinicians will be timed completing the traditional FRAT and new screening forms. This outcome is assessed with a stop watch and study‐specific questionnaire.[June 2019] (iii) whether any differences are detected in time attributed to fall prevention actions in response to either FRAT form. Assessments will be done of at least 100 patient histories from each hospital site to check the time attributed to fall prevention actions in response to either FRAT form. This outcome is assessed with a study‐specific questionnaire.[June 2019] (iv) fidelity of screening type (per hospital group allocation). This outcome is assessed with a stop watch and study‐specific questionnaire.[June 2019] (v) Inpatient‐fall‐related healthcare resource use for participants in each trial arm. This will be estimated from fall‐related incident reports, audits of healthcare resources consumed for serious fall‐related injury cases that consume substantial healthcare resources (e.g., fractures, head injuries), and use of hospital administrative records for participants in each trial arm. [June 2019] Labour consumed for fall prevention‐related activities (based on estimates of time taken to complete fall‐risk screening and fall‐prevention activities actions) will also contribute to clinician labour time estimates for inpatient‐fall‐related healthcare resource use. This outcome is assessed with a stop watch and study‐specific questionnaire.[June 2019] INCLUSION CRITERIA: All wards (except paediatric, maternity, emergency and theatre wards) will be sampled from 10 Private hospitals in Australia.