Examining the Relationship Between Environmental Factors and Inpatient Hospital Falls: Protocol for a Mixed Methods Study.
Examining the Relationship Between Environmental Factors and Inpatient Hospital Falls: Protocol for a Mixed Methods Study.
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DOI：
10.2196/24974
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发表时间：
2021-07-13
影响因子：
1.7
通讯作者：
Fischer GM
中科院分区：
文献类型：
--
作者：
Shorr RI;Ahrentzen S;Luther SL;Radwan C;Hahm B;Kazemzadeh M;Alliance S;Powell-Cope G;Fischer GM
患者跌倒是医院报告的最常见的不良事件。虽然众所周知，医院的物理环境导致了近40%的严重或致命的医院跌倒，但在住院病房设计与跌倒率之间的关系方面，人们的认识存在显著差距。检验单位设计的少数研究是在单一医院（非退伍军人健康管理局[VHA]）或少数住院单位进行的，限制了通用性。本研究的目的是确定单位设计因素，有助于住院病人跌倒在VHA。本研究的第一个目的是调查前线和管理人员对退伍军人跌倒的看法和经验，因为它们与住院环境因素有关。将使用一个迭代的快速评估过程来分析数据。访谈结果将直接为环境评估调查的发展提供信息，该调查将作为目标2的一部分进行，并有助于解释目标2。本研究的第二个目的是量化单位设计因素，并比较单位的空间和环境因素与较高和较低的预期下降率。我们将首先对3个VHA医疗中心的10个医疗/外科单位的设施人员进行演练访谈，以确定环境跌倒风险因素。数据将用于完成护士管理人员和设施管理人员的环境评估调查。然后，我们将使用来自VA住院患者评估中心的跌倒数据和来自其他来源的患者数据来确定50个医疗/外科护理单位的跌倒率高于和低于预期。我们将通过分析单元平面图的计算机辅助设计文件和环境评价调查中的环境因素来测量空间因素。将进行统计检验，以确定区分高和低异常值的设计因素。退伍军人事务部卫生服务研究与发展服务部批准了这项研究的资金。研究方案得到了两个地点的机构审查委员会和退伍军人事务部研究委员会的批准。数据收集始于2018年2月。数据分析结果预计将于2022年2月公布。目标1的数据收集和分析已经完成，正在编写结果手稿。为实现目标2，将医疗/外科单位分为摔倒率高于预期和低于预期两类，将环境评估调查分发给设施管理人员和护士管理人员。正在编制测量空间特征的数据。据我们所知，这项研究是第一个客观地确定在大型多医院系统内医院跌倒的空间风险。研究结果有助于医院的循证设计指南，如设施指南研究所和退伍军人事务部的指南。表征空间特征的指标是定量指标，可以纳入更大规模的背景研究，研究导致跌倒的因素，迄今为止，这些研究往往排除了单位层面的物理环境因素。在未来的研究中，空间句法测量可以作为物理环境因素，用于检查导致患者跌倒的一系列背景因素——社会、个人、组织和环境。derr1 - 10.2196/24974
Patient falls are the most common adverse events reported in hospitals. Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or fatal hospital falls, there are significant gaps in the knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital (non-Veterans Health Administration [VHA]) or a small number of inpatient units, limiting generalizability. The goal of this study is to identify unit design factors contributing to inpatient falls in the VHA. The first aim of the study is to investigate frontline and management perceptions of and experiences with veteran falls as they pertain to inpatient environmental factors. An iterative rapid assessment process will be used to analyze the data. Interview findings will directly inform the development of an environmental assessment survey to be conducted as part of aim 2 and to contribute to interpretation of aim 2. The second aim of this study is to quantify unit design factors and compare spatial and environmental factors of units with higher- versus lower-than-expected fall rates. We will first conduct walk-through interviews with facility personnel in 10 medical/surgical units at 3 VHA medical centers to identify environmental fall risk factors. Data will be used to finalize an environmental assessment survey for nurse managers and facilities managers. We will then use fall data from the VA Inpatient Evaluation Center and patient data from additional sources to identify 50 medical/surgical nursing units with higher- and lower-than-expected fall rates. We will measure spatial factors by analyzing computer-aided design files of unit floorplans and environmental factors from the environmental assessment survey. Statistical tests will be performed to identify design factors that distinguish high and low outliers. The VA Health Services Research and Development Service approved funding for the study. The research protocol was approved by institutional review boards and VA research committees at both sites. Data collection started in February 2018. Results of the data analysis are expected by February 2022. Data collection and analysis was completed for aim 1 with a manuscript of results in progress. For aim 2, the medical/surgical units were categorized into higher- and lower-than-expected fall categories, the environmental assessment surveys were distributed to facility managers and nurse managers. Data to measure spatial characteristics are being compiled. To our knowledge, this study is the first to objectively identify spatial risks for falls in hospitals within in a large multihospital system. Findings can contribute to evidence-based design guidelines for hospitals such as those of the Facility Guidelines Institute and the Department of Veterans Affairs. The metrics for characterizing spatial features are quantitative indices that could be incorporated in larger scale contextual studies examining contributors to falls, which to date often exclude physical environmental factors at the unit level. Space syntax measures could be used as physical environmental factors in future research examining a range of contextual factors—social, personal, organizational, and environmental—that contribute to patient falls. DERR1-10.2196/24974
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影响因子：
6.3
作者：
Florence CS;Bergen G;Atherly A;Burns E;Stevens J;Drake C
通讯作者：
Drake C
DOI：
10.1016/s1553-7250(12)38052-5
发表时间：
2012-09-01
影响因子：
2.3
作者：
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通讯作者：
Shorr, Ronald I.
影响因子：
1.2
作者：
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通讯作者：
White, Susan V.
影响因子：
39.2
作者：
Miake-Lye, Isomi M.;Hempel, Susanne;Shekelle, Paul G.
通讯作者：
Shekelle, Paul G.
影响因子：
2
作者：
Kolin, M. Melissa;Minnier, Tamara;Thompson, Lucy E.
通讯作者：
Thompson, Lucy E.