Implementation of a Multifactorial Fall Risk Assessment at North Estonia Medical Centre

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

1. 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
2. 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
3. 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
4. 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
5. 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