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2020 Validation of the Hendrich II Fall Risk Model®

The latest validation study of the Hendrich II Fall Risk Model® is now available. The “Validation of the Hendrich II Fall Risk Model®: The imperative to reduce modifiable risk factors.” Applied Nursing Research is available to download and read here.

This Hendrich II Fall Risk Model® research is among the largest published validation studies focused on fall risk assessment tools within a peer-reviewed article. Over a span of three years, this study evaluated over 214,000 patients across nine different acute care facilities. 

High Sensitivity and Specificity in Diverse Populations

The HIIFRM demonstrated a sensitivity of 78.72% and specificity of 64.07% at risk score ≥ 5. The AUC of 0.765 indicates moderate predictive accuracy. It is important to note that the study was conducted in hospitals in which fall prevention programs were long-standing with continuous fall reduction goals in place, which was documented to have reduced the fall rate over many years, thereby artificially reducing the AUC and underestimating diagnostic accuracy. The duration of this study (3 years), the large sample size, and the representative diversity of the study population support the generalizability of the findings and should minimize the impact of variations in local practice patterns.

These results compare favorably to previous studies of the HIIFRM and other fall risk tools. Published studies of the HIIFRM, using various methodologies (e.g., retrospective case-control, prospective observational, cross-sectional) and undertaken across various clinical settings (e.g., general acute care, geriatric acute care, psychiatric care, re- habilitation) and countries (e.g., China, Portugal, Italy, Lebanon), have reported AUC of 0.62 to 0.82, sensitivities of 45.8% to 100%, and specificities of 35% to 89.3%.  However, no study of the HIIFRM or any other fall risk model included as robust and diverse a patient sample from acute-care settings representative of hospitals nationwide as the current study.

The standard cut-off score to define high fall risk on the HIIFRM is ≥5. The findings of this study demonstrate that patients with a fall risk score of 4 still have a moderate risk of falling. If ≥4 had been used as the cutoff, an additional 74 falls could have been identified, with a corresponding trade-off in lower specificity (see Table 3 in the article). A cut-off of ≥4 would add 42,036 patients to the 77,292 patients with scores ≥5, for a total of 119,328 at-risk inpatients, or 55.7% of the entire sample, a 54.4% increase in the number of patients under modifiable risk factor or injurious fall reduction protocols. Of the 74 patients with a risk score of 4 who fell, it is not possible to know how many would have avoided a fall if they had been categorized as high risk.

Abstracted from Validation of the Hendrich II Fall Risk Model: The imperative to reduce modifiable risk factors, Applied Nursing Research 53 (2020) 151243.

Here are a few highlights:

  • This study validates the reliability of the Hendrich II Fall Risk Model®.
  • Most inpatients have numerous, underlying fall risk factors.
  • Injurious fall reduction requires a focus that expands beyond environmental factors.
  • Modifiable fall risk factors should be connected to evidence-based interventions.
  • Promotion of safe mobility will require policy and practice changes for most acute care fall programs.

The study found that a large number of patients had multiple fall risk factors (n = 77,292), which aren’t typically managed during hospitalization, left them at risk to fall in the hospital and after discharge. The study proved healthcare teams have a large opportunity to reduce injurious falls through the active management of modifiable risk factors. 

It’s imperative that evidence-based interventions are utilized by the healthcare team.  Nursing interventions often stop at environmental safety, armbands, socks, and signs. Outcomes will improve when a continuum of care model is used by providers and acute care facilities to develop person-centered approaches to reduce modifiable risk factors.   

Reviewing the Validation of the Hendrich II Fall Risk Model®: The imperative to reduce modifiable risk factors is a great way to think about how your current fall risk model is being used or how this new research can be applied at your organization. 

Hendrich II Fall Risk Model® Validation Studies

The Hendrich II Fall Risk Model® has been validated in numerous studies and has repeatedly shown its ability to predict and prevent injurious falls in diverse populations, hospitals, and large healthcare systems. This validity and reliability is why it is used and integrated into the Electronic Health Record (EHR) in more than 1,000 sites of care. Click the link to learn more about the model validation studies.

View Validation Info

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