ABSTRACT
BACKGROUND: Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. METHODS: A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. RESULTS: A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. CONCLUSIONS: A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies. TRIAL REGISTRATION: The project was registered on the Clinical Trials Registry NCT04367298 (29/04/2020).
ABSTRACT
BACKGROUND: Accidental falls in hospitals are serious events concerning the safety of the patients. Recent studies demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. The aim of the study is to determine the effect of the application of a programme of preventive measures based on the temporal patterns of the risk factors on the hospital fall occurrence. METHODS: A mixed-method research design. The following three phases will be carried out: 1) Longitudinal prospective study in two parts: (a) audits and seminars of healthcare professionals focused on an effective and efficient hospital falls register. Multi-Component and Single Cosinor analyses will be performed to obtain the temporal patterns of hospital falls and their related variables and (b) implementation of a based-temporal patterns, multidimensional prevention programme. 2) Retrospective study of falls registered in institutional databases. 3) Qualitative study based on focus groups (physicians, nurses and nursing assistants). The study protocol was approved in 2018. DISCUSSION: With regard to the safety of patients, hospital falls are serious events. Recent studies have demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. It is imperative to study temporal patterns of hospital falls to effectively and comprehensively define the aetiology of falls and, therefore, design preventive strategies. A reduction of the number of in-hospital falls and related injuries is expected, as well as an improvement in the quality of life of patients. Considering temporal patterns and levels of mood and sleep of healthcare professionals will achieve an improvement in patient safety. TRIAL REGISTRATION: Retrospectively registered in ClinicalTrials.gov ID: NCT04367298.
ABSTRACT
Objetivo: Conocer las complicaciones que se han producido en pacientes mayores de 65 años, ingresados en un hospital andaluz de tercer nivel durante el año 2012, con diagnóstico principal de fractura de cadera. Metodología: Diseño: Se realizó un estudio descriptivo transversal. Ámbito, periodo y sujetos de estudio: Pacientes ingresados en el año 2012 mayores de 65 años con diagnóstico principal de fractura de cadera. Variables principales: Morbimortalidad recogida en el CMBD, analizada en función de otras variables que influyen en su aparición según la bibliografía (edad, sexo, comorbilidad, etc). Análisis estadístico de las variables con comparación de medias y proporciones con los programas estadísticos Epidat y G-Stat de uso libre. Resultados: La media de edad fue de 83,16 (6,68) años, y de estancia 10,2 días. La mortalidad fue del 4,99%. Las fracturas extracapsulares fueron más frecuentes que las intracapsulares, 64,24% y 35,76% respectivamente. La estancia media preoperatoria, 3,5 días. El tratamiento más frecuente la osteosíntesis, con un 62,6%. La complicación más frecuente, excluyendo el éxitus, complicaciones quirúrgicas- vías urinarias. El total de pacientes complicados fue del 8,7%, incluyendo los fallecidos. El sexo masculino, la edad avanzada y la demora quirúrgica se asocian con aparición de complicaciones. Los porcentajes más altos de complicación se dieron en pacientes con tres comorbilidades asociadas. Conclusión: La presencia de complicaciones en el período de hospitalización de pacientes ancianos ingresados por fractura de cadera se relaciona con sexo masculino, edad avanzada, demora quirúrgica y mayor número de comorbilidades (AU)
Purpose: To know the complications that occurred in patients over 65 years admitted to an Andalusian tertiary hospital during 2012 with a primary diagnosis of hip fracture. Methodology: Design: Cross-sectional study. Scope, period and cohort: Patients admitted in 2012 over 65 years with a primary diagnosis of hip fracture. Main outcomes: Morbidity and mortality collected in the Andalusian Minimum Data Set , analyzed in terms of other variables that influence their occurrence according to the literature (age, sex, comorbidity, etc). Instruments: Statistical analysis has been done with Epidat and G-Stat, statistical free software, to get and compare means and proportions of the variables. Results: The mean age was 83.16(6.68) years old. The mortality rate was 4.99%. The average length of stay was 10.2 days. Extracapsular fractures were more frequent than intracapsular ones, 64.24% and 35.76% respectively. The average preoperative stay was 3.5 days. The most frequent treatment was osteosynthesis, with 62.6%. The most common complication, excluding exitus, was surgical urinary tract complications. Total complicated patients was 8.7%, including the deceased. Male gender, older age and surgical delay was associated with development of complications. The highest percentages of complications occurred in patients with three comorbidities. Conclusion: The presence of complications during the period of hospitalization of elderly patients admitted for hip fracture is associated with male gender, older age, surgical delay and more comorbidities (AU)
