Do hospital fall prevention programs work? A systematic review.

OBJECTIVES: To analyze published hospital fall prevention programs to deter mine whether there is any effect on fall rates. To review the methodologica l quality of those programs and the range of interventions used. To provide directions fur further research. DESIGN: Systematic review of published hospital fall prevention programs, M eta-analysis. METHODS: Keyword searches of Medline, CINAHL, monographs, and secondary ref erences. All papers were included that described fall rates before and duri ng intervention. Risk ratios and 95% Confidence Intervals (95% CI) were est imated and random effects meta-analysis employed. Begg's test was applied t o detect possible publication bias. Separate meta-analysis regressions were performed to determine whether individual components of multifaceted inter ventions were effective. RESULTS: A total of 21 papers met the criteria (18 from North America), alt hough only 10 contained sufficient data to allow calculation of confidence intervals. A rate ratio of <1 indicates a reduction in the fall rate, resul ting from an intervention. Three were randomized controlled trials (pooled rate ratio 1.0 (CI 0.60, 1.68)), seven prospective studies with, historical control (0.76 (CI 0.55, 0.88)). Pooled effect rate ratio from these 10 stu dies was 0.79 (CI 0.69, 0.89). The remaining 11 studies were prospective st udies with historical control describing fall rates only. Individual compon ents uf interventions showed no significant benefit. DISCUSSION: The pooled effect of about 25% reduction in the fall rate may b e a result of intervention but may also be biased by studies that used hist orical controls not allowing for historical trends in the fall rate before and during the intervention. The randomized controlled trials apparent lack of effect might be due to a change in practice when patients and controls were in the same unit at the same time during a study. Studies did not anal yze compliance with the intervention or opportunity costs resulting from th e intervention. Research and clinical programs in hospital fall prevention should pay more attention to study design and the nature of interventions.