Key issues to consider and innovative ideas on fall prevention in the geriatric department of a teaching hospital

Falls in hospital are common and up to 70% result in injury, leading to increased length of stay and accounting for 10% of patient safety-related deaths. Yet, high-quality evidence guiding best practice is lacking. Fall prevention strategies have worked in some trials but not in others. Differences in study setting (acute, subacute, rehabilitation) and sampling of patients (cognitively intact or impaired) may explain the difference in results. This article discusses these important issues and describes the strategies to prevent falls in the acute hospital setting we have studied, which engage the cognitively impaired who are more likely to fall. We have used video clips rather than verbal instruction to educate patients, and are optimistic that this approach may work. We have also explored the option of co-locating high fall risk patients in a close observation room for supervision, with promising results. Further studies, using larger sample sizes are required to confirm our findings. Practice Impact: Our article may redirect the future research focus of falls in hospital (particularly in the acute setting) from multifactorial to a single intervention approach (targeting toileting). The silent video to alert a person to fall risk is one such approach. The co-location of high fall risk patients is another.