Step Wedge Cluster Randomised Trial of a Service Intervention to Reduce Falls in Hospital
试验速览
- 阶段
- 不适用
- 入组人数
- 9
- 试验地点
- 1
- 主要终点
- Rates of falls per thousand occupied bed days.
研究概览
简要总结
The head of nursing at University Hospital Coventry and Warwickshire (UHCW) plans to roll out an intervention across groups of hospital wards over the next four months. The intervention is designed to reduce falls as part of quality improvement for the hospital. However, the head of nursing has asked the University of Warwick to help with the scientific evaluation of the intervention - to find out whether and to what extent falls on the wards are reduced by the intervention. The University of Warwick will have two functions:
- To analyse data on falls to see if there has been a statistically significant drop in fall rates before and after the intervention has been implemented across these groups of wards
- To determine a random order in which the groups of wards receive the intervention as this will make it easier to distinguish cause and effect.
详细描述
Falls are the most commonly reported patient safety incident with 240,000 recorded in NHS hospitals in England each year. The national mean rate of falls per 1000 occupied bed day (OBDs) is 6.6. The rate of harm per 1000 OBD is 0.19. The head of nursing at UHCW is responsible for quality and safety in nursing and recognises that falls are a problem at UHCW. Consequently she plans to implement an intervention (an educational programme for ward staff) to reduce the potential harm caused by falls, and wishes to know whether the intervention is effective. For logistical reasons it is not possible to introduce the intervention to all wards at the same time, so it is necessary to roll the intervention out across clusters of wards over time. These clusters will be the unit of study. Human Subjects Protection Review will be exempt as the intervention is taking place at ward level, not the patient level. The hypothesis is that fall rates will tend to decline after the intervention is introduced. Standards for prevention of falls have been published by the Healthcare Quality Improvement Partnership (Royal College of Physicians. National Audit of Inpatient Falls: audit report 2015. London: RCP, 2015). The intervention will consist of education to improve compliance with these standards.
NIHR CLAHRC West Midlands were approached to conduct an independent evaluation. However, the service imperative does not permit any delay in implementation of the intervention. Although the intervention must not be delayed, it cannot be implemented simultaneously across all hospital wards; it must be rolled out incrementally. The unit of roll-out is a cluster of wards. There are nine clusters of wards:
Cluster A:
- Ward 40 - Gerontology - Age
- Ward 20 - Gerontology
- Ward 21 - Gerontology
Cluster B:
研究设计
- 研究类型
- Observational
- 观察模型
- Ecologic Or Community
- 时间视角
- Retrospective
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •All patients on ward
排除标准
- 未提供
结局指标
主要结局
Rates of falls per thousand occupied bed days.
时间窗: Fall rates will be collated monthly over a one year period to provide a median of approximately six months pre- and six months post-intervention data points.
We hypothesize that fall rates will decrease per 1000 Occupied Bed Days
次要结局
未报告次要终点
研究者
Professor Richard Lilford
Director of the Collaborations for Leadership in Applied Health Research and Care West Midlands (CLAHRC WM)
University of Warwick