Automated Fall Detection Algorithm With Global Trigger Tool, Incident Reports, Manual Chart Review, and Patient-Reported Falls: Algorithm Development and Validation With a Retrospective Diagnostic Accuracy Study

Abstract

Background Falls are common adverse events in hospitals, frequently leading to additional health costs due to prolonged stays and extra care. Therefore, reliable fall detection is vital to develop and test fall prevention strategies. However, conventional methods—voluntary incident reports and manual chart reviews—are error-prone and time consuming, respectively. Using a search algorithm to examine patients’ electronic health record data and flag fall indicators offers an inexpensive, sensitive, cost-effective alternative. Objective This study’s purpose was to develop a fall detection algorithm for use with electronic health record data, then to evaluate it alongside the Global Trigger Tool, incident reports, a manual chart review, and patient-reported falls. Methods Conducted on 2 campuses of a large hospital system in Switzerland, this retrospective diagnostic accuracy study consisted of 2 substudies: the first, targeting 240 patients, for algorithm development and the second, targeting 298 patients, for validation. In the development study, we compared the new algorithm’s in-hospital fall rates with those indicated by the Global Trigger Tool and incident reports; in the validation study, we compared the algorithm’s in-hospital fall rates with those from patient-reported falls and manual chart review. We compared the various methods by calculating sensitivity, specificity, and predictive values. Results Twenty in-hospital falls were discovered in the development study sample. Of these, the algorithm detected 19 (sensitivity 95%), the Global Trigger Tool detected 18 (90%), and incident reports detected 14 (67%). Of the 15 falls found in the validation sample, the algorithm identified all 15 (100%), the manual chart review identified 14 (93%), and the patient-reported fall measure identified 5 (33%). Owing to relatively high numbers of false positives based on falls present on admission, the algorithm’s positive predictive values were 50% (development sample) and 47% (validation sample). Instead of requiring 10 minutes per case for a full manual review or 20 minutes to apply the Global Trigger Tool, the algorithm requires only a few seconds, after which only the positive results (roughly 11% of the full case number) require review. Conclusions The newly developed electronic health record algorithm demonstrated very high sensitivity for fall detection. Applied in near real time, the algorithm can record in-hospital falls events effectively and help to develop and test fall prevention measures.