Talking about falls: a qualitative exploration of spoken communication of patients’ fall risks in hospitals and implications for multifactorial approaches to fall prevention

Background: Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients’ levels of falls risk, but multifactorial approaches are now recommended, which target individual, modifiable falls risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel for such communication, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about falls prevention and how this supports multifactorial falls prevention practice.
Methods: Data were collected through semi-structured qualitative interviews with 50 staff and ethnographic observations of falls prevention practices (251.25 hours) on orthopaedic and older person wards in four English hospitals. Findings were analysed using a framework approach.
Findings: We observed staff engaging in ‘multifactorial talk’ in both informal and formal conversations, where staff talked about addressing patients’ modifiable risk factors. This took place especially during multidisciplinary meetings which were patient- rather than risk-type focused. Such communication co-existed with ‘categorisation talk’, which focused on patients’ levels of falls risk and allocating nursing supervision to ‘high risk’ patients. Staff negotiated the tensions between these different approaches through frequent ‘hybrid talk’, where, as well as categorising risks, they also discussed how to modify them.
Conclusion: To support hospitals in implementing multifactorial, multidisciplinary falls prevention, we recommend: (1) focusing on patients’ individual risk factors and actions to address them (a ‘why?’ rather than a ‘who’ approach); (2) where it’s not possible to avoid ‘high risk’ categorisations, employing ‘hybrid’ communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; (4) timing meetings to enable staff from different disciplines to participate.