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Talking about falls: a qualitative exploration of spoken communication of patients’ fall risks in hospitals and implications for multifactorial approaches to fall prevention
  1. Lynn McVey1,
  2. Natasha Alvarado1,
  3. Frances Healey2,
  4. Jane Montague1,
  5. Chris Todd3,
  6. Hadar Zaman4,
  7. Dawn Dowding3,
  8. Alison Lynch5,
  9. Basma Issa6,
  10. Rebecca Randell1
  1. 1 Faculty of Health Studies, University of Bradford, Bradford, UK
  2. 2 Leeds and York Partnership NHS Foundation Trust, Leeds, UK
  3. 3 School of Health Sciences, University of Manchester, Manchester, UK
  4. 4 School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
  5. 5 Manchester Clinical Academic Centre, Manchester University NHS Foundation Trust, Manchester, UK
  6. 6 Patient/public author, University of Bradford, Bradford, UK
  1. Correspondence to Dr Lynn McVey, University of Bradford Faculty of Health Studies, Bradford, UK; L.McVey{at}


Background Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients’ levels of fall risk, but multifactorial approaches are now recommended. These target individual, modifiable fall risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about fall prevention and how this supports multifactorial fall prevention practice.

Methods Data were collected through semistructured qualitative interviews with 50 staff and ethnographic observations of fall 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’ to address patients’ modifiable risk factors, especially during multidisciplinary meetings which were patient focused rather than risk type focused. Such communication coexisted with ‘categorisation talk’, which focused on patients’ levels of fall risk and allocating nursing supervision to ‘high risk’ patients. Staff negotiated 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 fall prevention, we recommend: (1) focusing on patients’ individual risk factors and actions to address them (a ‘why?’ rather than a ‘who’ approach); (2) where 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; and (4) timing meetings to enable staff from different disciplines to participate.

  • Communication
  • Hand-off
  • Patient safety
  • Shared decision making
  • Risk management

Data availability statement

Data are available upon reasonable request. The datasets associated with this study are available from the corresponding author on reasonable request and only in accordance with the stipulations of the ethics approval.

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Data availability statement

Data are available upon reasonable request. The datasets associated with this study are available from the corresponding author on reasonable request and only in accordance with the stipulations of the ethics approval.

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  • Contributors LM: formal analysis, investigation, methodology, project administration, writing—original draft. NA: conceptualisation, formal analysis, funding acquisition, investigation, methodology, project administration, writing—review and editing. FH and DD: conceptualisation, funding acquisition, methodology, writing—review and editing. JM: writing—review and editing. CT: conceptualisation, methodology, writing—review and editing. HZ, AL and BI (BI is a patient/public author): methodology, writing—review and editing. RR: conceptualisation, formal analysis, funding acquisition, guarantor, investigation, methodology, project administration, supervision, writing—review and editing.

  • Funding This study is funded by Health Services and Delivery Research Programme (HSDR NIHR129488). The views and opinions expressed are those of the authors and do not necessarily reflect those of the Health Services and Delivery Research Programme, National Institute for Health and Care Research, the National Health Service or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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