• Users Online: 453
  • Print this page
  • Email this page

Table of Contents
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 135-138

Protocol of identification of effective factors in reducing fall among the hospitalized patients: A systematic review

1 Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Health in Emergencies and Disasters, School of Public Health and Safety; Department of Health in Emergencies and Disasters, Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission13-May-2020
Date of Decision19-May-2020
Date of Acceptance20-Jun-2020
Date of Web Publication22-Aug-2020

Correspondence Address:
Dr. Davoud Khorasani-Zavareh
Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/atr.atr_40_20

Rights and Permissions

Background: The patient's fall is one of the factors threatening the patient's health in hospitals and medical centers. More than 12% of patients fall once during the hospitalization period, which in some cases leads to disability or death. Therefore, falling prevention is one of the essential issues in the hospital and requires interventions. Objectives: The aim of this study was to examine the effective factors in controlling the hurts caused by patient fall. Methods: This study was conducted to present a protocol for identifying the effective factors of patient fall in hospitals. For this purpose, four international databases were investigated and searched, in two phases (databases are Scopus, PubMed, Web of Science, and ScienceDirect, along with Google Scholar). First, we selected and categorized the articles, using PRISMA instruction for systematic review studies. In the second phase, the findings were analyzed using thematic analysis; then, categories and subcategories were extracted. To examine the quality of studies, critical appraisal skills program, Newcastle–Ottawa Scale, and Strengthening the Reporting of Observational Studies in Epidemiology checklists were applied. Systematic Review Registration: PROSPERO CRD42020161328. Ethics and Dissemination: There is no human participation in the study, and after data analysis, the author prepared an article for a specialized journal. Permission to the study was obtained from the ethics committee of the Faculty of Health and Safety, affiliated to Shahid Beheshti University of Medical Sciences.

Keywords: Fall, hospital, hospitalization, patient, prevention

How to cite this article:
Mousavipour SS, Ghomian Z, Nouri F, Khorasani-Zavareh D. Protocol of identification of effective factors in reducing fall among the hospitalized patients: A systematic review. Arch Trauma Res 2020;9:135-8

How to cite this URL:
Mousavipour SS, Ghomian Z, Nouri F, Khorasani-Zavareh D. Protocol of identification of effective factors in reducing fall among the hospitalized patients: A systematic review. Arch Trauma Res [serial online] 2020 [cited 2023 Jan 29];9:135-8. Available from: https://www.archtrauma.com/text.asp?2020/9/3/135/292957

  Introduction Top

Hospital plays a key role in providing health and treatment services and reducing of hurts.[1] Patient fall in hospital is a common and serious issue for patients, their families, and for the health system. The incident may lead to injuries, disabilities and even death.[2],[3] According to the WHO, fall is an unintentional event that leads to fall of patient on the ground or on a lower surface. According to the national database of nursing quality indicators, fall is defined tumbling on the ground with or without injuries.[4] The prevalence of fall differs in various parts of the world, so that a review study reported the rate between 2.2% and 25%.[2],[3],[5] There are different factors in the increase of patients' fall in hospitals. There are also different approaches to control patient fall and each approach emphasizes on specific principles and rules, to reduce patient fall cases.[6],[7],[8],[9]

Falling among hospitalized patients is a repeatable process that can lead to adverse physical and psychological consequences, including injuries, disabilities, increased hospitalization period, fear of fall, stress, anxiety, depression, and decrease of physical activities, and in some cases death. These have negative effects on the quality of life, specifically if they need care from family members or health-care providers, they are more likely to develop emotional reactions that can affect a person's independence and rehabilitation.[5],[10],[11],[12],[13]

After nationwide implementation of the clinical domination plan by the Ministry of Health, Treatment, and Medical Education in Iran, the patient safety became the key concern in health centers. According to this plan, risk management and improvement of patient safety in health centers are the main measures for clinical creditability.[14] Since patient fall in hospitals is a major risk to health services efficiency, it is imperative to predict and prevent the incidents and provide equipment to control mortality, injuries, and disabilities.

Since identification of the effective factors in controlling patient fall is one of the safety criteria, the results of the study can be used for determining the strategies and adjusting therapeutic processes in national health system to control falls, injuries, as well as to improve health in the society.


The aim of this study was to identify the effective factors in decreasing the patient fall incidences in hospitals and to determine patient fall prevention strategies.

  Methods Top

Protocol design

The present study was a systematic review to find and categorize the related articles, based on the PRISMA instruction.[15] Afterward, the findings were organized as categories and subcategories using a thematic analysis. The whole research process including the search, selection of articles, quality assessment, and data extraction was performed by three experienced researchers.

Eligibility criteria

The author searched and considered all descriptive, analytical, and qualitative studies, based on inclusion criteria with no time limitation. Our pilot search showed that studies published after 1990 meet the criteria and methodology conditions.

Search strategy and information sources

Two independent researchers investigated the articles. This systematic review relies on different sources including PubMed, Scopus, Web of Science, ScienceDirect databases, and Google Scholar web search, as well as the key journals (based on Scopus), gray sources (conferences, dissertation, and reports), and other sources (webpage of pertinent organizations, book, and experts). Experts' opinion, medical subject MeSH websites, synonym dictionaries, and keywords in pertinent articles were applied to find synonym keywords. To write syntax, AND/OR operators would be used. The syntax for each database listed above was written independently, as in the appendixes and [Table 1].
Table 1: Search for electronic databases according to the number of the related articles, number of needed read, syntax and search steps in Web of Science, PubMed, Scopus and ScienceDirect databases to identify effective factors in reducing falls among the hospitalized patients

Click here to view

Study selection

After searching for synonyms, syntaxes were written according to the type of database and using the tag structure for each database. The search process was done on each database separately. The Number of Needed Read index was calculated at each stage of the search. The allocation of tags in each database was continued until the desired index value is between 12 and 15. After reaching the desired index, the articles enter EndNote.

Screening and data extraction

Inclusion criteria included all English-language articles published on the factors affecting the reduction of patient falls in the hospital and the consequences of intervention to prevent falls.

Exclusion criteria included articles that do not have the main text, studies that have not been on the approach to reducing patient falls, studies that are about reducing falls in certain groups outside the hospital, and non-English language articles.

Three independent researchers screened the articles and checked the titles and abstracts, based on the inclusion and exclusion criteria. Finally, the full texts of the articles were checked by the three researchers independently, and in case of disagreement, the problem would be settled by the fourth researcher. Data collection was done using a preplanned checklist, including information such as author's name, place of study, time of study, methodology, study population, and the key findings.

Quality of assessment

Quality assessment was conducted after primary selection of the scientific text and removal of repetitious papers, based on the type of articles and using critical appraisal skills program (CASP), Newcastle–Ottawa Scale, and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The Ottawa checklist includes eight items with scores from 0 to 10. So that, scores between 0 and 5 represent low quality, 6–7 represent moderate quality, and The value =8 represent good quality.[16] The CASP checklist consists of three sections and 10 questions, in total. The questions are answered by three alternatives (can't tell, no, yes) and papers that obtain more than 7 points enter the study. The STROBE checklist consists of 22 items and all covers all aspects of a study (objective, sampling, study plan, population, data collection, statistics, and results). The total score rages from 0 to 44. In general, studies were classified into three categories of low quality (<15.5), moderate quality (15.5–29.5), and high quality (29.5–44). Studies of low quality were excluded.

Ethics approval

The study was conducted after obtaining an approval from the Ethics Committee of Shahid Beheshti University of Medical Sciences.

Strengths and limitations of study

Designing a good methodology for policymakers in the Ministry of Health of Iran are among the strengths of the study. One of the limitations of this study is the impossibility of reviewing articles published in non-English language.

  Conclusion Top

The issue of falls has always been one of the concerns of officials in dealing with preventing and reducing hurts to patients in the hospital. According to the stated objective and the importance of the subject of never events, especially the fall of the patient, the researcher can identify solutions for preventing the fall of the patient at the hospitals. The information obtained from this study will be used to explain the clinical guidelines for preventing patient falls in Iranian hospitals. Ultimately, it will lead to scientific decisions and improve the readiness to prevent the patient from falling, in the areas of policymaking, planning, education and research at the hospital level, and promoting the health of the community.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bachri S, Fahmal AM, Hafidz MM. Hospital responsibility to the patients in implementation of health care. J Nurs Health Sci 2017;6:47-52.  Back to cited text no. 1
Oliver D, Connelly JB, Victor CR, Shaw FE, Whitehead A, Genc Y, et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses. BMJ 2007;334:82.  Back to cited text no. 2
Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med 2010;26:645-92.  Back to cited text no. 3
Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG. Inpatient fall prevention programs as a patient safety strategy: A systematic review. Ann Intern Med 2013;158:390-6.  Back to cited text no. 4
Healey F, Oliver D, Milne A, Connelly JB. The effect of bedrails on falls and injury: A systematic review of clinical studies. Age Ageing 2008;37:368-78.  Back to cited text no. 5
Oliver D, Papaioannou A, Giangregorio L, Thabane L, Reizgys K, Foster G. A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: How well does it work? Age Ageing 2008;37:621-7.  Back to cited text no. 6
Tinetti ME. Multifactorial fall-prevention strategies: Time to retreat or advance. J Am Geriatr Soc 2008;56:1563.  Back to cited text no. 7
MacCulloch PA, Gardner T, Bonner A. Comprehensive fall prevention programs across settings: A review of the literature. Geriatr Nurs 2007;28:306-11.  Back to cited text no. 8
Choi YS, Lawler E, Boenecke CA, Ponatoski ER, Zimring CM. Developing a multi-systemic fall prevention model, incorporating the physical environment, the care process and technology: A systematic review. J Adv Nurs 2011;67:2501-24.  Back to cited text no. 9
Chen JS, Simpson JM, March LM, Cameron ID, Cumming RG, Lord SR, et al. Risk factors for fracture following a fall among older people in residential care facilities in Australia. J Am Geriatr Soc 2008;56:2020-6.  Back to cited text no. 10
Coussement J, De Paepe L, Schwendimann R, Denhaerynck K, Dejaeger E, Milisen K. Interventions for preventing falls in acute and chronic-care hospitals: A systematic review and meta-analysis. J Am Geriatr Soc 2008;56:29-36.  Back to cited text no. 11
Kerzman H, Chetrit A, Brin L, Toren O. Characteristics of falls in hospitalized patients. J Adv Nurs 2004;47:223-9.  Back to cited text no. 12
Chen YC, Chien SF, Chen LK. Risk factors associated with falls among Chinese hospital inpatients in Taiwan. Arch Gerontol Geriatr 2009;48:132-6.  Back to cited text no. 13
Haidarpour p, Dastjerdi R, Rafiei S, Sadat SM, Mostofian F. Familiarity with the basics of clinical governance. Tehran: Ministry of Health and Medical Education; 2011. p. 112.  Back to cited text no. 14
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med 2009;6:e1000100.  Back to cited text no. 15
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010;25:603-5.  Back to cited text no. 16


  [Table 1]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded176    
    Comments [Add]    

Recommend this journal