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February 16, 2011

Preventing Falls in Acute Care Hospitals—Reply

JAMA. 2011;305(7):671-672. doi:10.1001/jama.2011.139

In Reply: We acknowledge the potential for underreporting of patient falls and in our article discussed this as a limitation. Because of funding restrictions, resources were used to develop and test components of the Fall Prevention Toolkit (FPTK), precluding use of additional data collection mechanisms as cited by Drs Haines and Healey. Since no prior trials demonstrated a significant decrease in falls in acute, short-stay hospitals, resources were expended to identify appropriate content and iterative design of the FPTK with end users.1-4 We relied on existing reporting systems, as has been done in the majority of studies of falls, which also allowed comparisons of outcomes from other studies with ours. There was no indication that differences in reporting on experimental vs control units occurred. Our study was not powered to measure the effect of the FPTK on injurious falls. A larger study with injurious falls as a primary outcome would be needed if the link between the FPTK and decreased falls is confirmed. As we noted, the FPTK was more effective in older patients for whom the number of injurious falls was higher in the control (n = 9) vs the experimental group (n = 7). However, we did not draw conclusions about less injurious falls seen in older patients in the experimental group because the difference was not statistically significant and the study was not powered to detect this outcome.