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 inJournal of the American Geriatrics Society (JAGS) Vol. 69; no. 9; pp. 2598 - 2604
Main Authors Morris, Meg E., Haines, Terry, Hill, Anne Marie, Cameron, Ian D., Jones, Cathy, Jazayeri, Dana, Mitra, Biswadev, Kiegaldie, Debra, Shorr, Ronald I., McPhail, Steven M.
Format Journal Article
LanguageEnglish
Published Hoboken, USA John Wiley & Sons, Inc 01.09.2021
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Abstract 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.
AbstractList We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Two-group, multi-site cluster-randomized active-control non-inferiority trial. Hospital wards. Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). 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. 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. 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. 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.
BACKGROUND/OBJECTIVESWe investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. DESIGNTwo-group, multi-site cluster-randomized active-control non-inferiority trial. SETTINGHospital wards. PARTICIPANTSAdult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). INTERVENTIONHospitals 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. MEASUREMENTSThe 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. RESULTSThe 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. CONCLUSIONReplacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
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.
Author Haines, Terry
Cameron, Ian D.
Jazayeri, Dana
Mitra, Biswadev
Shorr, Ronald I.
Hill, Anne Marie
Kiegaldie, Debra
McPhail, Steven M.
Jones, Cathy
Morris, Meg E.
AuthorAffiliation 5 John Walsh Centre for Rehabilitation Research Faculty of Medicine and Health, Kolling Institute, University of Sydney St. Leonards New South Wales Australia
6 Healthscope Melbourne Victoria Australia
3 School of Primary and Allied Health Care Monash University Melbourne Victoria Australia
7 School of Public Health & Preventive Medicine Monash University Melbourne Victoria Australia
2 La Trobe Centre for Sport and Exercise Medicine Research La Trobe University Bundoora Melbourne Australia
8 Holmesglen Institute Melbourne Victoria Australia
4 School of Physiotherapy and Exercise Science Curtin University Perth Western Australia Australia
11 Australian Centre for Health Services Innovation and Centre for Healthcare Transformation School of Public Health & Social Work, Faculty of Health, Queensland University of Technology Brisbane Queensland Australia
1 Healthscope ARCH Victorian Rehabilitation Centre Glen Waverley Victoria Australia
12 Clinical Informatics Directorate Metro South Health Brisban
AuthorAffiliation_xml – name: 11 Australian Centre for Health Services Innovation and Centre for Healthcare Transformation School of Public Health & Social Work, Faculty of Health, Queensland University of Technology Brisbane Queensland Australia
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Issue 9
Keywords disinvestment
screening
education
falls
non-inferiority
physiotherapy
safety
injury
hospital
health care
quality
Language English
License Attribution-NonCommercial-NoDerivs
2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
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Notes 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.
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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
ORCID 0000-0002-0114-4175
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Snippet Background/Objectives We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select...
We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation...
Background/ObjectivesWe investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select...
BACKGROUND/OBJECTIVESWe investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select...
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SourceType Open Access Repository
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Publisher
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SubjectTerms Brief Report
disinvestment
education
Falls
health care
Health risks
hospital
Hospitals
injury
Medical records
non‐inferiority
physiotherapy
quality
Regular Issue Content
Risk assessment
safety
screening
Title Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non‐Inferiority Trial
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjgs.17125
https://www.ncbi.nlm.nih.gov/pubmed/33834490
https://www.proquest.com/docview/2572187102
https://search.proquest.com/docview/2511238283
https://pubmed.ncbi.nlm.nih.gov/PMC8518986
Volume 69
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