Silver bullets or buckshot? Patient falls and a systems model in healthcare facility design

Falls are associated with increased length of stay in hospitals and higher healthcare costs connected to additional care, discharges to institutional care and litigation claims. Under current US reimbursement programs, organizations are penalized for hospital-acquired conditions, including falls with injury not present on admission. This paper presents the results from a systematic mixed methods literature review on the correlates and interventions for patient falls. While the review is focused on conditions of the physical environment, these must be considered in the context of organizational and people-based factors to fully address the system complexity. A model for systems integration is proposed. Practitioner Summary: Healthcare organizations continue to struggle with preventing patient falls. Because of the multifactorial contributions to fall risk, falls reduction programs include multiple solutions with no ability to quantify the effectiveness of any particular component, and yet, the question is always asked, “What really worked?” Rather than seek silver bullets, we should establish frameworks that account for the interactions within the system that also a proactive approach to healthcare facility design.