Shifting the Paradigm: An Assessment of the Quality of Fall Risk Reduction in Nebraska Hospitals

Purpose To assess the prevalence of evidence‐based fall risk reduction structures and processes in Nebraska hospitals; whether fall rates are associated with specific structures and processes; and whether fall risk reduction structures, processes, and outcomes vary by hospital type—Critical Access Hospital (CAH) versus non‐CAH. Methods A cross‐sectional survey of Nebraska's 83 general community hospitals, 78% of which are CAHs. We used a negative binomial rate model to estimate fall rates while adjusting for hospital volume (patient days) and the exact Pearson chi‐square test to determine associations between hospital type and the structure and process of fall risk reduction. Findings Approximately two‐thirds or more of 70 hospitals used 6 of 9 evidence‐based universal fall risk reduction interventions; 50% or more used 14 of 16 evidence‐based targeted interventions. After adjusting for hospital volume, hospitals in which teams integrated evidence from multiple disciplines and reflected upon data and modified polices/procedures based upon data had significantly lower total and injurious fall rates per 1,000 patient days than hospitals that did not. Non‐CAHs were significantly more likely than CAHs to perform 5 organizational‐level fall risk reduction processes. CAHs reported significantly greater total (5.9 vs 4.0) and injurious (1.7 vs 0.9) fall rates per 1,000 patient days than did non‐CAHs. Conclusions Hospital type was a significant predictor of fall rates. However, shifting the paradigm for fall risk reduction from a nursing‐centric approach to one in which teams implement evidence‐based practices and learn from data may decrease fall risk regardless of hospital type.