Clinicians’ perspectives and clinical efficacy of a health information technology tool in hospital falls risk assessment and prevention among older persons

Abstract

Background The expanding ageing population has resulted in a focus on older persons within many healthcare systems. Falls present a growing problem with a significant impact on the community and healthcare system. Identifying falls risk factors and preventing falls have become priorities for many hospital and government policies, yet the evidence for the acceptability and efficacy of such interventions remains limited. Health technology has the potential to influence the field of falls prevention. Within research and clinical use, single and multi-component health technology strategies have been trialled to identify falls risk and prevent falls incidents. These have included sensor systems, video surveillance, and electronic health records. This thesis sought to evaluate the role of health technology in falls risk assessment and prevention, its perceptions by clinicians as end-users, and its effectiveness in reducing falls in hospital. More specifically, the thesis examined clinicians’ perspectives and use of a health information technology tool. This tool incorporated an iPad™ device and automatically generated visual cues to highlight individual patients’ falls risk. Its accuracy and efficacy in identifying and addressing falls risk scenarios, was evaluated compared to a standard screening tool. The aim of this study was to ultimately develop an acceptable and usable tool, in collaboration with clinicians, to deliver effective falls prevention in hospital. Methods Two methodologies and separate analyses were undertaken to complete this thesis: 1) An integrative review collated evidence for the effectiveness and clinicians’ perspectives of health technology use in falls prevention; and 2) an action research study evaluated clinicians’ perspectives on the health information technology tool, and informs its clinical use and efficacy in reducing hospital fall rates. Data was derived from focus group and survey research, with implementation of the health information technology tool occurring over consecutive 12-week periods on two medical wards at a single hospital setting. Both qualitative and quantitative analyses were applied to the data. Results Integrative review evidence, presented for the first time in this thesis, highlighted the lack of robust, consistent evidence for the acceptability and efficacy of health technology measures in falls prevention. The research conducted in this thesis addressed this gap in knowledge by evaluating staff’s attitudes towards the health information technology tool. It evaluated its positive and negative aspects, barriers to use, and recommendations for improvement; alongside its accuracy and effectiveness in reducing fall rates. Overall, clinicians were supportive for incorporating the tool into clinical practice. They perceived it as a useful, timely means of alerting staff and patients to falls risk scenarios, and resulting in better quality of care and understanding of falls risk for patients. Clinicians identified issues with usability and lack of time for tool use, and highlighted potential improvements to tool design. As befitting action research methodology, the health information technology tool has undergone refinement based on clinicians’ feedback. This has resulted in improved technology, clearer functioning of selection keys, colour coding of patients’ falls risk, having an automated trigger for patient education on falls risk, and provision of more iPad™ devices for more efficient use. The falls risk scores for the health information technology tool and standard falls risk in older person screening tool were similar, and did not differentiate between falls-risk and non-risk situations. Both tools had high sensitivity and low specificity for identifying falls-risk scenarios. They had similar rates of completion by clinicians on the wards. Implementation of the intervention tool had mixed outcomes on hospital fall rates. Conclusion This thesis contributed new information to address the knowledge gap on health technology uptake and efficacy in addressing hospital falls risk. Clinicians were willing to use the health information technology tool, and identified benefits to using the tool for themselves and their patients. The intervention tool demonstrated similar acceptability and accuracy to the standard falls risk screening tool. Staff’s concerns about usability are addressed in tool refinement, with active participation of end-users were considered key to improving intervention acceptance and usage, along with maximising useful feedback to further inform tool development. The effect of implementing the intervention tool on fall rates was mixed, highlighting the challenges of identifying and managing falls risk scenarios in hospital settings. The work arising from this thesis informed the development of a hand held android device used in the Ambience Intelligence Geriatric Management (AmbiGEM) system, incorporating printed visual cues with movement sensor alarms that alert clinicians to high-risk patient manoeuvres. Future research directions will involve evaluation of the acceptability and efficacy of the AmbiGEM system, which is currently undergoing clinical trial in two hospitals in South and Western Australia.