Quantitative Research Article Evaluation: Fall Prevention in Acute Care Hospitals

Background or Introduction

In the introduction, the researchers have addressed the context, objective, relevance, and setting of the study. According to the authors, the primary objective of their study was to determine whether, through the use of health information technology (HIT) and fall prevention tool kit (FPTK), patient falls in hospitals can be significantly reduced. In the introductory section of their research article, the authors note that falls are a global public health problem which needs to be prevented as it is one of the leading causes of hospital deaths. Dykes et al. (2010) also note that falls and the related injuries have devastating impacts on clinicians, patients, and the healthcare system as a whole. They not only lead to reduced mobility and increased mortalities among older patients but also increase lengths of stay and hospital costs. The setting of the study was 4 hospitals in the US where patient fall rates were clinically compared in terms of the hospital units that received fall prevention interventions and those that received usual care. A total of 10 264 patients participated in the study.

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Review of the Literature

The article does not contain any specific literature review section per se. Rather, what the researchers have done is to draw inferences and evidence from previous studies to support their assertions, claims, and conclusions throughout the paper. While it is expected that the article ought to comprehensively and critically review or synthesize the variant literature on the subject of prevention of patient falls, this element is lacking is in these researchers' study. However, the authors have used literature which is relevant to the topic.

Discussion of Methodology

In the methodology section, the researchers detail how they conducted a cluster randomized study in four US Boston-based hospitals through the use of the Morse Falls Scale (MFS) for standardized risk assessment. According to the researchers, a total of three phases of the study were conducted in the development and testing of the FPTK components. The first phase involved a qualitative inquiry aimed at identifying the facilitators and barriers to fall risk interventions and communication. The second phase of the clinical trial entailed the use of the MFS risk factors in developing the FPTK prototype. The final phase involved a review of the FPTK to ascertain its validity and effectiveness in falls prevention in hospitals. To test the FPTK, the authors of this research conducted a cluster randomized study design and used the control units as a comparison for fall risk assessment and prevention.

Data Analysis

Data analysis was done statistically whereby the number and rates of falls for every 1000 patient-days in both the main and control studies were recorded and compared. To test for the variances in the rate of falls across the control groups and the intervention groups, the researchers used the Poisson regression model and in testing for any residual clustering effects, they used the generalized estimating equation methods. The researchers also applied the medians with interquartile ranges, means with standard deviations, and proportions in calculating the patient characteristics across the groups under study. The Wilcoxon test was applied in checking covariate balance while the SAS software, version 9.2 was used to carry out the statistical analyses.

Researcher's Conclusion

The researchers' main conclusion based on the results or outcomes of their study is that patient falls among older patients in acute care hospitals can be effectively prevented through the development and implementation of a healthcare information technology (HIT) intervention that specially targets the underlying risk areas. Their other conclusion is that even though the fall prevention toolkit proved to be effective at decreasing patient falls in both the control and intervention units for short-term patient hospital stays, there is a need for further studies to ascertain whether the same program can reduce repeat falls if evaluated over an extended period of time.

The evidence presented in the background or introductory section of the article does not support the researcher's conclusion since, according to the researchers, no study has been conducted indicating the effectiveness of HIT in falls prevention. At the earlier sections of the study, the authors' assertions are general in nature and hence do not support their final conclusion. However, at the literature review section of the journal article, the researchers' final conclusion is supported by the numerous studies which indicate that the implementation and use of technology can help prevent falls in hospitals by enhancing communication. Further, in the methodology section of the study, the final conclusion made by the authors is supported by the comparison in fall prevention tool it protocol for both the intervention and control units. In this section of the article, it is clear that patients in the intervention units suffered fewer falls than those in the control units, suggesting that the FPTK is effective in preventing falls in hospitals. Moreover, the data analysis section also supports the researchers' final conclusion in that it shows the differences between the numbers of falls among patients in both units. These variations can be clearly seen from the total number of falls, the total number of patients with falls, number of patient days, and hospital length of stay for both groups under study. However, from the tabular data, one may not at the onset determine whether the HIT program is effective in preventing falls.

Research ethics in nursing and healthcare, in general, requires that researchers take adequate and reasonable measures to protect human subjects from unfairness and exploitation or adverse impacts of the study on them. However, in the present study, there is no indication whatsoever that the researchers put in place precautionary measures to protect the human subjects. This is a major flaw of this study. Further, even though the study involved patients from different cultural backgrounds and age, no cultural considerations by the authors are evident from the article.

One of the main strengths of this study is that it represents the first randomized trial research study which has validated the effectiveness of health information technology and patient fall assessment tools in the prevention of falls in hospitals. Additionally, the study indicates the need for hospitals to apply technology in fall reduction by enhancing fall identification and reporting within hospitals. Also, according to Dykes et al. (2010), the inclusion of patients from hospitals having diverse information and documentation systems improved the generalizability of the FPTK. However, the fact that the intervention groups were not blinded and falls reporting done by caregivers responsile for implementing fall prevention interventions may have introduced bias in the study. Another limitation of the study is that it does not indicate whether the FPTK is only effective in reducing falls among elderly patients alone or with younger patients also (Dykes et al., 2010). The sample size could also not sufficiently determine the effectiveness of the FPTK. Further, there are other ways of preventing falls in hospitals more effectively than mere reliance on some technology software or program.

The evidence from this study informs nursing practice in that it validates the increasing calls for the implementation of healthcare technology not only in enhancing the quality of care but also reducing hospital errors, increasing efficiency, reducing hospital injuries, and reducing costs. The study shows the relevance and significance of healthcare information technology in enhancing patient safety by reducing incidences of patient falls in acute care and hospital settings.