Inpatient Fall Research Articles

81 IMPROVING THE ASSESSMENT AND PREVENTION OF FALLS AND FRACTURES ON A REHABILITATION WARD

Abstract Background The National Steering Group and The National Institute for Health and Care Excellence provide guidelines on medical assessment and prevention of falls and fractures. This audit assesses and compares quality of practice on an Age-Related rehabilitation ward against these guidelines. Methods A retrospective audit, including all patients (n=31) on an off-site, Age-Related rehabilitation ward was completed. Data on falls and fractures at emergency department presentation and during admission was obtained through chart review. Following education and implementation of a falls pro-forma, a re-audit was completed at four months including all patients (n=40). Results In cycle 1, mean age of patients was 80 years (range 56-94), 39 Percent (%) (n=12) were admitted with a fall of whom 66.7% (n=8) had a resulting fracture. In cycle 2, mean age was 82 years (range 63–95), 48% (n=19) were admitted due to a fall, of whom 53% (n=10) had a fracture. A falls assessment and bone health review was completed in 39% (n=12) of all patients in cycle 1, and in 37% (n=3) admitted with a fall. This increased to 83% (n=33) of all patients in cycle 2 and 100% (n=40) of those admitted with a fall. Pre-intervention, 23% (n=7) had an inpatient fall compared to 18% (n=7) post-intervention; of these, 43% (n=3) and 14% (n=1) resulted in fractures respectively. Conclusion Compliance with national guidelines for prevention of falls and fractures improved with education and implementation of a falls pro-forma. This resulted in a reduction in falls, particularly injurious falls, on a rehabilitation ward. In future, this pro-forma may be implemented in other hospital wards.

197 IMPROVING THE ASSESSMENT OF VISION IN OLDER ADULTS AT RISKS OF FALLS AT A DAY REHABILITATION CLINIC

Abstract Background Assessment of vision is a key component of multifactorial falls prevention programmes. However, the National Audit of Inpatient Falls (2015) found less than half of older adults had a vision assessment when admitted to hospital. We suspected vision assessment could also be improved for patients attending our outpatient Day Rehabilitation Unit who were falling or at risk of falls. Methods 21 outpatients were audited initially, with determination of baseline characteristics including age and Rockwood frailty score. We assessed whether past ophthalmological history was documented, whether the patient wore glasses and whether they had had a recent eye test in the community. Finally, documentation regarding visual examination was audited; this comprised range of eye movement, visual fields and visual acuity assessments. We adapted the clinic proforma to include a specific section on ophthalmology history and visual assessment; 14 patients were re-audited following intervention. Results Our two groups were relatively similar: mean age of 80 in the initial audit and 78 in the subsequent audit. Both groups had an average Rockwood score of 5. Improvements were noted in documentation regarding previous eye testing (33.3% - 86%), testing of eye movements (71.4% - 100%, and testing of visual fields (66.7% - 93%). There remained no testing of visual acuity following intervention. Conclusion A dedicated falls proforma targeting specific risk factors for falls improves identification and assessment of those risks. This enables targeted intervention and referral to be made to improve patient outcomes. For further improvement we would recommend educating the multidisciplinary team on how to test for visual acuity in the outpatient setting.

Development and validation of interpretable machine learning models for inpatient fall events and electronic medical record integration.

Falls are one of the most frequently occurring adverse events among hospitalized patients. The Morse Fall Scale, which has been widely used for fall risk assessment, has the two limitations of low specificity and difficulty in practical implementation. The aim of this study was to develop and validate an interpretable machine learning model for prediction of falls to be integrated in an electronic medical record (EMR) system. This was a retrospective study involving a tertiary teaching hospital in Seoul, Korea. Based on the literature, 83 known predictors were grouped into seven categories. Interpretable fall event prediction models were developed using multiple machine learning models including gradient boosting and Shapley values. Overall, 191,778 cases with 272 fall events (0.1%) were included in the analysis. With the validation cohort of 2020, the area under the receiver operating curve (AUROC) of the gradient boosting model was 0.817 (95% confidence interval [CI], 0.720-0.904), better performance than random forest (AUROC, 0.801; 95% CI, 0.708-0.890), logistic regression (AUROC, 0.802; 95% CI, 0.721-0.878), artificial neural net (AUROC, 0.736; 95% CI, 0.650-0.821), and conventional Morse fall score (AUROC, 0.652; 95% CI, 0.570-0.715). The model's interpretability was enhanced at both the population and patient levels. The algorithm was later integrated into the current EMR system. We developed an interpretable machine learning prediction model for inpatient fall events using EMR integration formats.

Team approach to fall reduction in paediatric ward of national referral hospital, Thimphu, Bhutan: a quality improvement initiative

Falls are common and preventable adverse events that occur in a hospital setting. Falls can cause pain, damage, increase cost and mistrust in the health system. Inpatient fall is a...

Knowledge and perception of fall prevention in hospital: A survey of nursing staff

Dear Editor, Hospital falls are a common debilitating problem worldwide and are associated with negative patient outcomes and increased financial costs to organisations.1,2 While current research has demonstrated the positive impact of a multifaceted fall prevention programme in hospitals, results have been mixed in showing a statistically significant decline in inpatient fall rate.3 Understanding and

Relying on myself: The lived experience of being at risk for falling in the hospital among older adults

Inpatient fall rates have not significantly decreased the last decade. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to understand the lived experiences of being at risk for falling in the hospital among older adults. Nine participants (N=9) aged 65 years and older (female=55%) were interviewed twice using online video-conferencing after hospital discharge, and interview data was analyzed using van Manen's interpretive phenomenological method. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. Additional fall prevention interventions supporting hospitalized older adults’ self-management of fall risk are needed.

Assessment of the predictive ability of the Johns Hopkins Fall Risk Assessment Tool (Chinese Version) in inpatient settings.

This study was to assess the predictive ability of the Johns Hopkins Fall Risk Assessment Tool (Chinese Version) in inpatient settings. A case-control study. This study was conducted in a tertiary hospital based on 2019 data. With a case-control design in a 1:2 ratio, the predictive ability of the Johns Hopkins Fall Risk Assessment Tool (Chinese Version) was determined by ROC curve. The best cut point was identified based on sensitivity, specificity, positive predict value and negative predict value. Conditional logistical regression analysis was conducted to test the predictive ability of each indicator. The study included 309 patients, with 103 in the case group and 206 in the control groups. Generally, the predictive ability was acceptable with the area under ROC curve value at 0.73 (95% CI: 0.67-0.79). Positive predict value and negative predict value performed best at the cut point of 13. Sensitivity at cut point 6 was much higher than that at cut point 13, though specificity was lower. Except for age, all indicators in the Johns Hopkins Fall Risk Assessment Tool (Chinese Version) demonstrated significant predictive ability as to occurrence of fall. The Johns Hopkins Fall Risk Assessment Tool (Chinese Version) is a reliable assessment instrumentin the inpatient settings. This is the first study that evaluated the predictive ability of the Johns Hopkins Fall Risk Assessment Tool (Chinese version) in the inpatient settings, and proved that the instrument is reliable for assessing inpatient fall risks. Further studies could be carried out to assess the predict ability of Johns Hopkins Fall Risk Assessment Tool (Chinese version) among specific populations.

985 A QUALITY IMPROVEMENT PROJECT ON CALL BELL IN REACH IN AN ACUTE OLDER PERSON MEDICINE WARD (AGE > 85 YEARS)

Abstract Introduction Call bell within reach of patients is an important part of quality care and standard in the National Inpatient Falls Audit. Initial data collection showed 56% of patients had call bell in reach indicating potential for improvement Understanding the problem: Discussion with stakeholders included: Healthcare support worker, nurses & doctors of all grades, physio, and occupational therapist. Aim We aimed to improve call bell reach-ability from 56% to 95% or more for patients on the ward. Method Data were collected from 2 bays (Total 10 beds) on the ward three times a week for 2 weeks after implementation of each change assuming it should roughly reflect the whole ward. Balancing measure Inpatient falls on the ward (weekly data for the ward). Changes 1st Change: Stickers in medical notes as a reminder 2nd Change: Teaching session to staff nurses 3rd Change: A short video posted in a closed social group of ward 4th Change: Make a component in the safety huddle & reminder in daily nursing handover. Results After the 4th PDSA cycle, the call bell in reach was 93.88% which was sustained improvement. Inpatient fall did not show any specific correlation with call bell reach-ability and specific fall data for those 10 beds was not available separately Learning: • Teaching is effective but it may not be able to involve all the staff especially when staffing is not consistent. Despite attending the teaching, implementation of gained knowledge from the teaching session may not sustain. • Social media can be used to improve patient care provided that it’s closed media & no patient confidentiality is hampered but again may not be a solution. • Reminding the staff of the importance was our most effective change, possibly because of its proximity to patient care immediately being delivered afterward.

IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit: Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

AimsThis international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. MethodsA multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. ResultsA total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. ConclusionThe prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality risk. Among COVID-19-positive patients, those who were older, male, with renal or pulmonary disease had a significantly higher 30-day mortality risk.

The Fall Risk Screening Scale Is Suitable for Evaluating Adult Patient Fall.

(1) Background: This study aimed to test the feasibility of utilizing the screening tool for fall risk assessment in adult inpatient and verify its accuracy in a medical center in Taiwan. (2) Methods: This study retrospectively collected all adult fall cases among inpatients occurring in the general wards of a medical center between 1 January 2013 and 31 December 2015. This inpatient fall risk screening scale was measured by the sensitivity, specificity, and accuracy. (3) Results: There were 1331 (0.4%) falls among a total of 357,395 inpatients during this period. Factors predictive of falling risk included: age, consciousness, body shift assistance, use of fall risk medications, fall history, dizziness or weakness, toileting, and impaired mobility. Using the eight-factor assessment, two was the best cutoff point for identifying the fall risk group, with area under Receiver Operating Characteristic (ROC) curve (AUC) = 0.817, sensitivity = 80.93%, specificity = 73.0%, accuracy = 73.03%, and likelihood ratio = 11.48. (4) Conclusions: The accuracy of the eight-item fall risk assessment tool created for this study was validated. These results can serve as a reference for institutions to develop more effective fall risk assessment scale for inpatients, enabling clinical nurses to identify and more comprehensively assess the groups at highest risk for falling during their hospital stay.

Hospital performance comparison of inpatient fall rates; the impact of risk adjusting for patient-related factors: a multicentre cross-sectional survey

BackgroundComparing inpatient fall rates can serve as a benchmark for quality improvement. To improve the comparability of performance between hospitals, adjustments for patient-related fall risk factors that are not modifiable by care are recommended. Thereafter, the remaining variability in risk-adjusted fall rates can be attributed to differences in quality of care provided by a hospital. Research on risk-adjusted fall rates and their impact on hospital comparisons is currently sparse. Therefore, the aims of this study were to develop an inpatient fall risk adjustment model based on patient-related fall risk factors, and to analyse the impact of applying this model on comparisons of inpatient fall rates in acute care hospitals in Switzerland.MethodsData on inpatient falls in Swiss acute care hospitals were collected on one day in 2017, 2018 and 2019, as part of an annual multicentre cross-sectional survey. After excluding maternity and outpatient wards, all inpatients older than 18 years were included. Two-level logistic regression models were used to construct unadjusted and risk-adjusted caterpillar plots to compare inter-hospital variability in inpatient fall rates.ResultsOne hundred thirty eight hospitals and 35,998 patients were included in the analysis. Risk adjustment showed that the following factors were associated with a higher risk of falling: increasing care dependency (to a great extent care dependent, odds ratio 3.43, 95% confidence interval 2.78–4.23), a fall in the last 12 months (OR 2.14, CI 1.89–2.42), the intake of sedative and or psychotropic medications (OR 1.74, CI 1.54–1.98), mental and behavioural disorders (OR 1.55, CI 1.36–1.77) and higher age (OR 1.01, CI 1.01–1.02). With odds ratios between 1.26 and 0.67, eight further ICD-10 diagnosis groups were included. Female sex (OR 0.78, CI 0.70–0.88) and postoperative patients (OR 0.83, CI 0.73–0.95) were associated with a lower risk of falling. Unadjusted caterpillar plots identified 20 low- and 3 high-performing hospitals. After risk adjustment, 2 low-performing hospitals remained.ConclusionsRisk adjustment of inpatient fall rates could reduce misclassification of hospital performance and enables a fairer basis for decision-making and quality improvement measures. Patient-related fall risk factors such as care dependency, history of falls and cognitive impairment should be routinely assessed.

Knowledge, attitudes on falls and awareness of hospitalized patient's fall risk factors among the nurses working in Tertiary Care Hospitals

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Background&lt;/title&gt; &lt;p&gt;Fall is the most common patient safety incident in health care organizations. This study was initiated to obtain information regarding knowledge &amp;amp; attitude on falls and awareness of fall risk factors among nurses to device evidence-based and multidisciplinary educational and training programs to improve patient safety and thereby reduce morbidity and mortality associated with falls.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Methods&lt;/title&gt; &lt;p&gt;A descriptive cross-sectional survey study was conducted among 339 registered nurses working in Tertiary care hospitals across Chennai, Tamil Nadu, India. A modified version of the previously validated standard questionnaire was administered by the investigators through an online survey method to explore the level of knowledge &amp;amp; attitude on falls and awareness of inpatient fall risk factors among Nurses.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;In this study, 15.6% of participants had adequate knowledge of falls, 57.2% had a favorable attitude towards falls and 38.3% had adequate awareness of fall risk factors. Years of experience in nursing has a statistically significant association with the level of knowledge on fall. The participant's attitude towards falls had a statistically significant relationship with age, education, experience in nursing, and previous patient fall experience. The correlation between fall knowledge, the attitude toward falls, and awareness of fall risk factors were highly significant. The majority of the participants expressed their favorable attitude toward the need for fall preventive education.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusion&lt;/title&gt; &lt;p&gt;In our study, it is evident that there is a void that has to be filled to improve the knowledge, attitude, and awareness of falls and their risk factors. There is a need for extensive education and holistic, multifactorial, and interdisciplinary training program to be undertaken through various health care organizations.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Relying on Myself: The Lived Experience of Being at Risk for Falling in the Hospital Among Older Adults

Inpatient falls are a persistent problem and despite research efforts during the last decade, inpatient fall rates have not significantly decreased. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to gain a deeper understanding of the lived experiences of being at risk for falling in the hospital among older adults aged 65 years and older (N=9). Participants (female=55%, age range=67 – 86) were interviewed twice using video conferencing within two weeks of hospital discharge. The audio-recorded interviews were transcribed, and then analyzed using van Manen’s interpretive phenomenological method. The Health Belief Model expanded with the concepts of independence, fear of falling, embarrassment, dignity, and positivity effect served as the theoretical framework. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. These themes describe how the participants thoughtfully planned their mobilization to avoid falls. This process was influenced by their struggling to remain independent, following the hospital fall prevention rules out of politeness, and experiencing both positive and negative relationships with nursing staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. These findings have not been previously documented in the literature. Fall prevention interventions supporting hospitalized older adults’ self-management of fall risk are needed.

Pattern Analysis of Inpatient Falls in a Tertiary Hospital.

We analyzed the spatial and temporal patterns of inpatient falls in a tertiary hospital. Data were obtained from the adverse-event self-reporting system and the electronic nursing record system of the hospital. Through chart reviews we reclassified the cases. Most falls occurred by the bedside, followed by the restroom and hallway, and they occurred most often between 2 a.m. and 6 a.m. These findings indicate when and where nurses should be most alert about falls.

Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series.

BackgroundPatient falls are a common cause of harm in acute-care hospitals worldwide. They are a difficult, complex, and common problem requiring a great deal of nurses’ time, attention, and effort in practice. The recent rapid expansion of health care predictive analytic applications and the growing availability of electronic health record (EHR) data have resulted in the development of machine learning models that predict adverse events. However, the clinical impact of these models in terms of patient outcomes and clinicians’ responses is undetermined.ObjectiveThe purpose of this study was to determine the impact of an electronic analytic tool for predicting fall risk on patient outcomes and nurses’ responses.MethodsA controlled interrupted time series (ITS) experiment was conducted in 12 medical-surgical nursing units at a public hospital between May 2017 and April 2019. In six of the units, the patients’ fall risk was assessed using the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) system (control units), while in the other six, a predictive model for inpatient fall risks was implemented using routinely obtained data from the hospital’s EHR system (intervention units). The primary outcome was the rate of patient falls; secondary outcomes included the rate of falls with injury and analysis of process metrics (nursing interventions that are designed to mitigate the risk of fall).ResultsDuring the study period, there were 42,476 admissions, of which 707 were for falls and 134 for fall injuries. Allowing for differences in the patients’ characteristics and baseline process metrics, the number of patients with falls differed between the control (n=382) and intervention (n=325) units. The mean fall rate increased from 1.95 to 2.11 in control units and decreased from 1.92 to 1.79 in intervention units. A separate ITS analysis revealed that the immediate reduction was 29.73% in the intervention group (z=–2.06, P=.039) and 16.58% in the control group (z=–1.28, P=.20), but there was no ongoing effect. The injury rate did not differ significantly between the two groups (0.42 vs 0.31, z=1.50, P=.134). Among the process metrics, the risk-targeted interventions increased significantly over time in the intervention group.ConclusionsThis early-stage clinical evaluation revealed that implementation of an analytic tool for predicting fall risk may to contribute to an awareness of fall risk, leading to positive changes in nurses’ interventions over time.Trial RegistrationClinical Research Information Service (CRIS), Republic of Korea KCT0005286; https://cris.nih.go.kr/cris/search/detailSearch.do/16984

61 AUDIT: MEDICATION REVIEW POST INPATIENT FALLS

Abstract Background Falls are the most commonly reported incident in the Health Service Executive (HSE). Inappropriate medications and polypharmacy in the elderly can contribute to increased falls risk. Our aim was to assess whether a medication review was being completed at the time of the post-fall clinician review. Methods We completed a retrospective chart review using an audit tool of consecutive inpatient falls, resulting in serious injury, from March–December 2019. Standards measured against were: HSE Guideline—Service User Falls: A Practical Guide for Review, Medicines and Falls in Hospital: British Society Guidelines, STOPP &amp; START criteria and NICE Guidelines: Falls in Older People 2013. Results We identified 33 charts for review (n = 33)—54.55% (18) female and 45.45% (15) male. Average age was 81 ± 11.2 years. The immediate post-fall review was mainly completed by interns (48.49% (16)) and SHO’s (39.39% (13)). A medication review was carried out 9.09% (3) of the time. A total of n = 28 (84.85%) had poly pharmacy. When analysed for medications known to increase risk of falling, 51.52% (n = 17) were on anti-hypertensives, 45.45% (n = 15) on laxatives, 24.24% (n = 8) on sedative medications, 18.18% (n = 6) on hypnotics/anxiolytics, 15.15% (n = 5) on opioids and 15.15% (n = 5) on diuretics at the time of fall. The majority of these medications (77.42% (n = 24)) were commenced prior to admission. None of these medications were discontinued or the dose changed on review post fall. Conclusion Our audit demonstrates that in a cohort of patients who had an inpatient fall medication discontinuation and dose reductions were not performed. Yet, a high burden of polypharmacy and high-risk falls medication were found. This may result in missing a pertinent opportunity to prevent future falls. We advise a structured medication review is carried out for each patient who suffers an in-patient fall to efficiently modify such an easily identifiable risk factor.

Older adults' perceptions of their fall risk in the hospital: An integrative review.

The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. An integrative review. An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.

Video-Based Inpatient Fall Risk Assessment: A Case Study.

Inpatient falls are a serious safety issue in hospitals and healthcare facilities. Recent advances in video analytics for patient monitoring provide a non-intrusive avenue to reduce this risk through continuous activity monitoring. However, in- bed fall risk assessment systems have received less attention in the literature. The majority of prior studies have focused on fall event detection, and do not consider the circumstances that may indicate an imminent inpatient fall. Here, we propose a video-based system that can monitor the risk of a patient falling, and alert staff of unsafe behaviour to help prevent falls before they occur. We propose an approach that leverages recent advances in human localisation and skeleton pose estimation to extract spatial features from video frames recorded in a simulated environment. We demonstrate that body positions can be effectively recognised and provide useful evidence for fall risk assessment. This work highlights the benefits of video-based models for analysing behaviours of interest, and demonstrates how such a system could enable sufficient lead time for healthcare professionals to respond and address patient needs, which is necessary for the development of fall intervention programs.

Exploring the Environment behind In-Patient Falls and Their Relation to Hospital Overcrowdedness-A Register-Based Observational Study.

(1) Background: Inpatient falls are a serious threat to patients’ safety and their extrinsic factors are, at present, insufficiently described. Additionally, hospital overcrowdedness is known for its malicious effects but its relation to the inpatient falls is currently underexplored. The aim of this study was to explore the distribution of falls and their extrinsic characteristics amongst a range of different clinics, and to explore the correlation and predictive ability of hospital overcrowding in relation to inpatient falls. (2) Methods: An observational, cross-sectional, registry-based study was conducted using retrospective data from an incidence registry of a hospital organization in Sweden during 2018. The registry provided data regarding the extrinsic factors of inpatient falls, including the clinics’ overcrowdedness. Simple descriptive statistics, correlation analysis and simple linear regression analysis were used. (3) Results: Twelve clinics were included. A total of 870 inpatient falls were registered during 2018. Overcrowdedness and total amount of falls were positively and very strongly correlated (r = 0.875, p < 0.001). Overcrowdedness was a significant predictor of the total amount of inpatient falls (p < 0.001, α = 0.05). (4) Conclusions: The characteristics regarding inpatient falls vary among the clinics. Inpatient overcrowding might have a significant role in the prevalence of inpatient falls, but further high-evidence-level studies are required.

149 Reducing Complications and Improving Outcomes Following Total Hip Arthroplasty

Abstract Aim Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. Hip fracture fixation and arthroplasty are essential in improving pain and mobility. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes. Guay J’s Cochrane systematic review confirms that FIBs reduce pain pre and postoperatively, decrease hospital-acquired pneumonia risk and improve mobility. Patients on anticoagulants are typically refused bedside blocks, however we are unsure if they truly impact adverse outcomes in FIBs for NOF patients. Method A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was the result of an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&amp;E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge date. Results There were no local complications in all 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma and achieved good pain relief from the block. Conclusions FIBs appear to be a safe and effective analgesic tool in the perioperative NOF patient and use has been reported to reduce early complications in those who undergo hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.