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Falls among older adults in acute care hospitals are a major cause of morbidity and mortality, leading to serious injury, increased healthcare costs, and reduced quality of life. For this reason, it is important to investigate the effectiveness of different interventions in reducing the risk of falls. The PICOT question I have chosen to investigate is: In adults aged 65 and over (P) in acute care hospitals, how does the implementation of a multidisciplinary team-based approach (I) compared to the standard of care (C) affect the rate of falls (O) within a six-month period (T)?

The proposed intervention, a multidisciplinary team-based approach, may reduce the risk of falls in acute care hospitals through improved risk assessment, patient education, and targeted interventions. The comparison intervention is the standard of care that is typically provided in acute care hospitals and may include patient education, environmental assessment, and other interventions. The outcome of interest is the rate of falls within a six-month period.

The evidence I found indicates that the implementation of a multidisciplinary team-based approach is effective in reducing the rate of falls in acute care hospitals. A systematic review by Choi et al. (2023) found that the implementation of a multidisciplinary team-based approach was associated with a 25% reduction in the rate of falls in older adults in acute care hospitals. The review also found that the implementation of a multidisciplinary team-based approach was associated with a reduction in the risks of fall-related injuries.

To evaluate the effectiveness of the implementation of a multidisciplinary team-based approach in reducing the rate of falls in older adults in acute care hospitals, I would use a before-and-after study design. In this study design, the rate of falls would be measured before and after the implementation of the intervention (Siddique et al., 2021). This would allow us to compare the rate of falls before and after the implementation of the intervention and to determine if there was a significant reduction in the rate of falls after the implementation of the intervention.

In addition, I would also use a randomized controlled trial (RCT) to evaluate the effectiveness of the intervention. In this study design, participants would be randomly assigned to either the intervention or the control group. The intervention group would receive the multidisciplinary team-based approach, while the control group would receive the standard of care (Goldberg et al., 2019). The rate of falls in each group would then be measured at the end of the study period. This would allow us to compare the rate of falls between the two groups and to determine if the intervention was effective in reducing the rate of falls (Goldberg et al., 2019). By comparing the rate of falls between the intervention and control groups, it would be possible to identify any factors that may have contributed to the success or failure of the intervention, such as the age of the participants or the length of the intervention.

I would also use qualitative methods to evaluate the effectiveness of the intervention. Qualitative methods such as interviews and focus groups can provide valuable insight into the experiences of patients and healthcare providers with the intervention (Ibrahim et al., 2022). These methods can help to identify potential barriers and facilitators to the implementation of the intervention and can provide valuable information on how to improve the effectiveness of the intervention (Morris et al., 2022). Qualitative methods can also be used to identify areas of improvement in the design and delivery of the intervention. Qualitative methods can help to uncover any unintended consequences of the intervention so that they can be addressed.

In conclusion, the implementation of a multidisciplinary team-based approach in acute care hospitals may be effective in reducing the rate of falls in older adults. The proposed evaluation methods, including before-and-after studies, randomized controlled trials, and qualitative methods, can provide valuable information on the effectiveness of the intervention and can help to identify potential barriers and facilitators to implementation.

References

Choi, J.-Y., Rajaguru, V., Shin, J., & Kim, K. (2023). Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review. Archives of Gerontology and Geriatrics, 104, 104831. https://doi.org/10.1016/j.archger.2022.104831

Goldberg, E. M., Marks, S. J., Ilegbusi, A., Resnik, L., Strauss, D. H., & Merchant, R. C. (2019). GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data. Journal of the American Geriatrics Society, 68(1), 198–206. https://doi.org/10.1111/jgs.16210

Ibrahim, H., Harhara, T., Athar, S., Nair, S. C., & Kamour, A. M. (2022). Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges. Risk Management and Healthcare Policy, Volume 15(15), 141–149. https://doi.org/10.2147/rmhp.s347693

Morris, M. E., Webster, K., Jones, C., Hill, A.-M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Heng, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5). https://doi.org/10.1093/ageing/afac077

Siddique, S. M., Tipton, K., Leas, B., Greysen, S. R., Mull, N. K., Lane-Fall, M., McShea, K., & Tsou, A. Y. (2021). Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Network Open, 4(9), e2125846–e2125846. https://doi.org/10.1001/jamanetworkopen.2021.25846

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