Twice-Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients

Background/Objective Ineffective interdisciplinary communication has negative impacts on patient outcomes. The use of regular structured interdisciplinary bedside rounds (SIBR), where each patient interaction lasts 3-5 minutes, is a model of care that improves interdisciplinary communication. We evaluated the impact of SIBR on in-hospital falls. Design Prospective before-after study of older people hospitalized with acute illness. Setting Two side-by-side aged care wards in a university hospital in Sydney, Australia. Participants A total of 3,673 consecutive inpatients of mean age 83.8 +/- 7.7 years, with 1,703 before SIBR compared with 1,970 after SIBR. No patients were excluded from potential participation. Intervention Twice-weekly SIBR. Measurements Falls data were manually extracted from a mandatory institutional incident reporting database. Medical diagnoses were based on the Australian Refined Diagnosis Related Groups classification system. Injuries due to falls were corroborated using the institutional electronic medical record (Cerner PowerChart). Generalized estimating equations were used to evaluate the incidence rate ratio (IRR) of falls and fall-related injuries. A negative binomial distribution and a logarithmic link function were used to linearize regression equations. Results After SIBR, there were 7.4 falls per 1,000 occupied bed days (OBD), compared with 10.6 falls per 1,000 OBD before SIBR (P < .001). The implementation of SIBR reduced falls (IRR = 0.67, 95% CI = 0.52-0.85), after adjusting for age, gender, cognitive impairment, behavioral and psychological symptoms of dementia, deconditioning and frailty, but not fall-related injuries (IRR = 0.79, 95% CI = 0.52-1.20). Conclusion This study is the first to investigate the effect of SIBR on in-hospital falls. It provides evidence that a sustainable, twice-weekly intervention is associated with a reduction in falls. It has the potential to be used in other settings where falls are frequent.

Automated summary

This study evaluated the impact of structured interdisciplinary bedside rounds (SIBR) on in-hospital falls among older patients with acute illness. The results showed that SIBR implementation led to a reduction in falls but did not significantly decrease fall-related injuries.