Adela M. Greeley, MD *; Elizabeth P. Tanner, MD *; Selene Mak, PhD, MPH; Meron M. Begashaw, MPH; Isomi M. Miake-Lye, PhD; Paul G. Shekelle, MD, PhD
Disclaimer: This article is based on research conducted by the Evidence-based Synthesis Program Center located at the West Los Angeles Veterans Affairs Medical Center, Los Angeles, California, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.
Financial Support: By the Veterans Affairs Quality Enhancement Research Initiative.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2628.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Registered in PROSPERO (CRD42019127424). Statistical code: Not applicable. Data set: Available in the Supplement and in the full evidence report (5).
Corresponding Author: Paul G. Shekelle, MD, PhD, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073; e-mail, Paul.Shekelle@va.gov.
Current Author Addresses: Drs. Greeley, Mak, Miake-Lye, and Shekelle and Ms. Begashaw: West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Dr. Tanner: UCLA Geriatrics, 10945 Le Conte Avenue, Suite 2339, Peter V. Ueberroth Building, Los Angeles, CA 90095.
Author Contributions: Conception and design: A.M. Greeley, E.P. Tanner, P.G. Shekelle.
Analysis and interpretation of the data: A.M. Greeley, E.P. Tanner, S. Mak, P.G. Shekelle.
Drafting of the article: A.M. Greeley, E.P. Tanner, M.M. Begashaw, P.G. Shekelle.
Critical revision of the article for important intellectual content: A.M. Greeley, E.P. Tanner, P.G. Shekelle.
Final approval of the article: A.M. Greeley, E.P. Tanner, S. Mak, M.M. Begashaw, I.M. Miake-Lye, P.G. Shekelle.
Provision of study materials or patients: M.M. Begashaw, I.M. Miake-Lye.
Obtaining of funding: I.M. Miake-Lye, P.G. Shekelle.
Administrative, technical, or logistic support: S. Mak, M.M. Begashaw, I.M. Miake-Lye.
Collection and assembly of data: A.M. Greeley, E.P. Tanner, S. Mak, M.M. Begashaw, I.M. Miake-Lye, P.G. Shekelle.
Bedside “sitters” are often used for patients at high risk for falls, but they are expensive and their effectiveness is unclear.
To review evidence about the effect of sitters and alternatives to sitters on patient falls in acute care hospitals.
PubMed searches to 8 October 2019, other databases from inception to December 2018, citation searches on key articles, and a Google search (22 October 2019).
English-language studies of any design that assessed the effect of adding sitters to usual care or compared alternatives to sitters (for example, video monitors or “close observation units”) for adult patients on general wards of acute care hospitals and reported falls as a primary outcome.
Dual-reviewer extraction of study data and risk of bias; single reviewer with group discussion for GRADE (Grading of Recommendations Assessment, Development and Evaluation) certainty of evidence.
Of 20 studies meeting inclusion criteria, 2 added sitters to usual care and 18 compared alternatives to sitters. There were no randomized trials, 11 time-series studies, 1 retrospective quasi-experimental study, and 8 pre–post studies. All studies had at least 1 methodological limitation. Two studies provided very-low-certainty evidence that adding sitters reduced falls. Eight studies provided moderate-certainty evidence that interventions that included video monitoring reduced sitter use and either did not affect or reduced the number of falls. Very-low-certainty evidence suggested that interventions that included nurse assessment tools (3 studies) or a close observation unit (2 studies) were effective alternatives to sitters.
No studies had low risk of bias, publication bias is likely, and studies may have been missed.
Despite a compelling rationale, evidence is scant that adding sitters to usual care reduces falls.
Veterans Affairs Quality Enhancement Research Initiative. (PROSPERO: CRD42019127424)
Greeley AM, Tanner EP, Mak S, et al. Sitters as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic Review. Ann Intern Med. 2020;:. [Epub ahead of print 4 February 2020]. doi: https://doi.org/10.7326/M19-2628
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Published: Ann Intern Med. 2020.
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