Using the CFIR-ERIC approach to enhance the uptake of a digital fall prevention platform: a quasi-experimental pre-post implementation study

Background Falls are a major cause of hospital acquired complications and inpatient harm. Interventions (including tools and processes) to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study sought to evaluate falls prevention workflows delivered through Rauland Australia’s Concentric Care fall prevention platform in a new hospital and ascertain the impact of an implementation enhancement plan on uptake. Methods A quasi-experimental interventional study using a pre-post implementation design measured: 1) The effectiveness of fall prevention workflows, focusing on patient and health service outcomes 2) Implementation effectiveness as reflected in both subjective and objective measures. Both quantitative and qualitative data were collected at two key time points: 1) Shortly after implementation 2) Six months after delivering a co-designed implementation enhancement plan, devised from stakeholder interviews coded to the Consolidated Framework for Implementation Research (CFIR) and mapped to the Expert Recommendations for Implementing Change (ERIC) tool. Results A risk reduction in falls per 1000 bed days was observed among cognitively intact patients post implementation enhancement plan, however, this difference was not statistically significant (OR = 0.97 95% CI [0.78,1.22] p = .77). Efficiencies in staff voice response times were identified (mean 41 seconds pre and 31 seconds’ post; 32% improvement, p <.0001). The implementation enhancement plan successfully improved the uptake of some key platform functions, most importantly, a (+39% (p = .04) increase in setting a patient as a high-falls risk on the staff station console. There were also improvements in staff satisfaction and perceptions of the fall prevention platform. Conclusions The implementation enhancement plan improved uptake of the platform and is likely to be effective for other similar interventions. The platform shows the potential to reduce falls among cognitively intact patients, but longer periods of observation and a larger sample are needed to confirm the effect. Aside from falls, the efficiencies in response time are likely to improve patient care and experience.