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Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms
  1. Sasha J Cuttler1,2,
  2. Jill Barr-Walker3,
  3. Lauren Cuttler4
  1. 1Collaborative Alliance for Nursing Outcomes Coordinator, San Francisco General Hospital, San Francisco, California, USA
  2. 2Physiological Nursing, University of California San Francisco, San Francisco, California, USA
  3. 3ZSFG Library, University of California, San Francisco, California, USA
  4. 4Department of Nursing, City College of San Francisco, San Francisco, California, USA
  1. Correspondence to Sasha J Cuttler, Collaborative Alliance for Nursing Outcomes Coordinator; sasha.cuttler{at}


Background Inpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods.

Objective To evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates.

Design Performance improvement study with historic control.

Setting Four medical-surgical units in one US public acute care hospital.

Study participants Adult medical-surgical inpatients units.

Interventions A 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients’ bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling.

Main outcome measures The main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009–September 2010 (baseline) with the follow-up period of January 2015–December 2015 (intervention).

Results Falls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented.

Conclusion The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.

  • adverse events, epidemiology and detection
  • patient safety
  • nurses
  • patient education

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors SJC was the principal investigator who initiated and designed the study, coordinated the implementation and analysed the data. JBW assisted with the literature review. LC cowrote and directed the patient education video.

  • Funding Hill-Rom Inc. supported the study to fund the production of the patient education video, loan of the tablet devices, preparation and mounting of the icons, stipend for research assistants, statistics consultant, open access fee and editing of manuscript. Hill Rom Inc. had no role in the design and conduct ofthe study; collection, analysis, or interpretation of the data; or preparationor approval of the manuscript

  • Competing interests None declared.

  • Ethics approval According to the policy regarding activities that constitute research at the hospital, this study met the criteria for operational improvement activities exempt from human subjects institutional review board review. Volunteers and staff were instructed to protect patient confidentiality and data were de-identified before submission for data analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The complete set of icons is available upon email request from the corresponding author (SJC).

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