Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non‐Inferiority Trial
Background/Objectives We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial. Setting Hospital wards. Par...
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Published in | Journal of the American Geriatrics Society (JAGS) Vol. 69; no. 9; pp. 2598 - 2604 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.09.2021
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background/Objectives
We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies.
Design
Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial.
Setting
Hospital wards.
Participants
Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days).
Intervention
Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list.
Measurements
The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated.
Results
The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively.
Conclusion
Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence. |
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Bibliography: | Funding information that this work is confirmatory of recent novel clinical research by Jellett et al. (2020). Jellett J, Williams C, Clayton D, Plummer V, Haines T. Falls risk score removal does not impact inpatient falls: A stepped‐wedge, cluster‐randomised trial. J Clin Nurs. 2020;29(23–24):4505–4513. We certify National Health and Medical Research Council, Grant/Award Number: 1152853 SourceType-Scholarly Journals-1 ObjectType-Feature-4 ObjectType-Undefined-1 ObjectType-News-2 content type line 23 ObjectType-Article-3 We certify that this work is confirmatory of recent novel clinical research by Jellett et al. (2020). Jellett J, Williams C, Clayton D, Plummer V, Haines T. Falls risk score removal does not impact inpatient falls: A stepped‐wedge, cluster‐randomised trial. J Clin Nurs. 2020;29(23–24):4505–4513. Funding information National Health and Medical Research Council, Grant/Award Number: 1152853 |
ISSN: | 0002-8614 1532-5415 |
DOI: | 10.1111/jgs.17125 |