Where are falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi-structured interviews of key informants at six Australian health services

Background: Falls are a major problem for patients and hospitals, resulting in death, disability and increased costs of healthcare. Objectives: This study aimed to estimate the resource allocation across a partnership of large health services, in an attempt to understand the amount and variability of resource allocation to various falls prevention activities. Design: A cross sectional survey using semi-structured interviews. Setting: Six tertiary health services in Australia. Participants: A collaboration of six health services, spanning twenty-eight hospitals, was formed to investigate falls prevention resource allocation. We interviewed 186 health service staff who were involved in falls prevention activities, such as projects, audits and risk management, clinical and operational managers responsible for falls prevention resource allocation and clinical staff on targeted acute, subacute and mental health wards. Methods: This study used a mixed methods, cross sectional, observational design. To collect data, we used key informant interviews with a purposive and snowball sampled group of people working in the included health services. During interviews, study participants were asked where and how falls prevention resources and equipment were utilised and to estimate the time allocated to performing falls prevention activities. The opportunity cost of each activity was estimated. All costs were reported in Australian dollars. Results: We estimate the annual opportunity cost of health service attempts to prevent in-hospital falls across the six health services to be AU$46,478,014. If we extrapolate this to a national level, health services would be consuming AU$590 million per year in resources trying to prevent falls in hospital. The areas of greatest resource consumption were physiotherapy (18%), continuous patient observers (14%), falls assessments (12%) and screens (8%), and falls prevention alarms (11%). Falls prevention alarms and falls risk assessment screening tools were also used only for falls prevention, and are potentially ineffective falls prevention strategies. Conclusions: Health services are investing considerable amounts of resource in attempting to prevent falls. However much of this resource is consumed in activities with weak or little evidence of effectiveness. Health services may be better served by considering tighter targeting, reduction or disinvestment in this area. This may release time and resources which could be used to provide interventions with a stronger evidence base, such as patient education using a structured patient education program or in other areas of practice where evidence of benefit exist.