Implementation of a Multifactorial Fall Risk Assessment at North Estonia Medical Centre
Abstract
Background
Falls and fall-related injuries are a common healthcare concern, particularly among patients over the age of 65³. It is estimated that nearly one million patients fall during hospitalization worldwide each year. Of those who fall, 25–30% sustain injuries², and 4–10% suffer serious harm²,⁵. Conducting an individualized assessment enables the application of the most appropriate, evidence-based prevention strategies tailored to each patient¹,⁶. An internal review of patient falls at North Estonia Medical Centre in 2023 showed that preventive actions were not systematically tailored to individual risk factors. In response, a hospital-wide development project was launched in March 2024.
Aim
To implement a structured, evidence-based MFRA at North Estonia Medical Centre to enable early identification of individual risk factors and targeted prevention.
Methods
The process included two phases: (1) Selection and adaptation of an evidence-based MFRA to the hospital context; (2) Staff training and hospital-wide implementation, with effectiveness evaluated through qualitative feedback from clinical practice.
Results
Staff feedback highlighted: (1) Improved awareness of patient-specific risks and more targeted prevention; (2) Challenges with time constraints and need for continuous training.
Conclusions
The analysis confirmed that the interplay of multiple risk factors significantly increases the likelihood of falls. Implementing a multifactorial fall risk assessment supported a more systematic approach to prevention by supporting earlier identification of individual risk factors and more targeted interventions.
Staff feedback indicated that the assessment was well-integrable into clinical workflows and added value to routine practice. Further attention should be directed towards ongoing staff training and implementation support to ensure the consistent and effective use of the assessment. Despite the implementation of multifactorial fall risk assessment at the North Estonia Medical Centre, there remains a clear need for a national strategy to ensure a harmonised, coordinated, and evidence-based approach to fall prevention across the Estonian healthcare system.
References
- Alvarado, N., McVey, L., & Wright, J. (2023). Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review. BioMed Central Geriatrics, 23, 381. https://doi.org/10.1186/s12877-023-04045-3
- Dykes, P. C., Curtin-Bowen, M., Lipsitz, S., et al. (2023). Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program. Journal of the American Medical Association Health Forum, 4(1). https://doi.org/10.1001/jamahealthforum.2022.5125
- Ganz, D. A., Latham, N. K. (2020). Prevention of falls in community-dwelling older adults. The New England Journal of Medicine, 382, 734–743. https://doi.org/10.1056/NEJMcp190325
- LeLaurin, J. H., Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007
- Vandervelde, S., Van den Bosch, N., Vlaeyen, E. (2024). Determinants influencing the implementation of multifactorial falls risk assessment and multidomain interventions in community-dwelling older people: a systematic review. Age and Ageing, 53(7). https://doi.org/10.1093/ageing/afae123
Keywords Fall prevention (MeSH), Quality improvement (MeSH), Fall risk assessment, Multifactorial assessment
Comments
Selection and development of implementation strategies
Great job, I understand this work is part of a bigger national implementation project, but I'd like to know a few more things of your process:
*I am really interested in how you identified the implementation challenges mentioned above and how you decided on staff training as your implementation strategy
*What else did you include in your implementation plan (implementers, determinants, theory-based methods for implementation change, etc)?
Finally, did you follow any implementation framework to guide your work?
Thanks!
Thank you for your question…
Thank you for your question.
Actually, this was not part of a national implementation project. Unfortunately, there is currently no national falls prevention programme or implementation strategy in Estonia.
This implementation project was initiated and developed at North Estonia Medical Centre following a fatal inpatient fall in 2021. The aim was to improve inpatient falls prevention and to standardize multifactorial fall risk assessment and documentation across the hospital.
The main implementation challenges were identified during the preparation and pilot phases through discussions with clinical staff, a review of existing practices, and analysis of documentation processes. We found considerable variation in fall risk assessment and documentation practices, as well as differences in staff knowledge regarding multifactorial fall risk assessment.
Therefore, staff training was selected as a key implementation strategy to support the adoption of the MFRA tool and its integration into daily clinical practice. This was complemented by practical guidance, e-learning, local champions, and continuous feedback throughout the implementation process.
Our implementation plan included establishing a multidisciplinary falls prevention network, adapting the MFRA tool to our local context, integrating standardized documentation into the electronic health record, developing an e-learning programme, maintaining continuous communication with staff, and monitoring implementation through audits and feedback. The aim was to support sustainable changes in everyday clinical practice.
No, we did not formally use a specific implementation science framework. The project was developed locally at North Estonia Medical Centre and was guided by quality improvement principles. Our approach focused on identifying local needs and barriers, engaging key stakeholders, adapting the intervention to the clinical context, providing staff education, and continuously monitoring implementation progress.
Although a formal implementation framework was not applied, several elements of our approach are consistent with implementation science principles, including stakeholder engagement, education, feedback, local champions, and continuous evaluation.
We believe that the success of implementing multifactorial fall risk assessment depends not only on the assessment tool itself, but also on continuous staff engagement, education, and organizational support. Our experience demonstrates that meaningful improvements in falls prevention can be achieved through a structured, multidisciplinary approach tailored to the local clinical context.
Thank you for your interest in our work.