Shifting the paradigm: An assessment of the quality of fall risk reduction in Nebraska hospitals

Katherine J. Jones, Dawn M. Venema, Regina Nailon, Anne M. Skinner, Robin High, Victoria Kennel

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: To assess the prevalence of evidence-based fall risk reduction structures and processes in Nebraska hospitals; whether fall rates are associated with specific structures and processes; and whether fall risk reduction structures, processes, and outcomes vary by hospital type-Critical Access Hospital (CAH) versus non-CAH. Methods: A cross-sectional survey of Nebraska's 83 general community hospitals, 78% of which are CAHs. We used a negative binomial rate model to estimate fall rates while adjusting for hospital volume (patient days) and the exact Pearson chi-square test to determine associations between hospital type and the structure and process of fall risk reduction. Findings: Approximately two-thirds or more of 70 hospitals used 6 of 9 evidence-based universal fall risk reduction interventions; 50% or more used 14 of 16 evidence-based targeted interventions. After adjusting for hospital volume, hospitals in which teams integrated evidence from multiple disciplines and reflected upon data and modified polices/procedures based upon data had significantly lower total and injurious fall rates per 1,000 patient days than hospitals that did not. Non-CAHs were significantly more likely than CAHs to perform 5 organizational-level fall risk reduction processes. CAHs reported significantly greater total (5.9 vs 4.0) and injurious (1.7 vs 0.9) fall rates per 1,000 patient days than did non-CAHs. Conclusions: Hospital type was a significant predictor of fall rates. However, shifting the paradigm for fall risk reduction from a nursing-centric approach to one in which teams implement evidence-based practices and learn from data may decrease fall risk regardless of hospital type.

Original languageEnglish (US)
Pages (from-to)135-145
Number of pages11
JournalJournal of Rural Health
Issue number2
StatePublished - Mar 1 2015


  • Critical access hospitals
  • Organizational learning
  • Patient falls
  • Quality
  • Teamwork

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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