59 Implementation strategies of fall prevention interventions in hospitals: A systematic review 3 it becomes possible to examine the relationship between the implementation strategy and the desired outcome. To our knowledge, a comprehensive systematic review of implementation strategies used for FPIs and their impact on fall rates in hospitalized patients have not been conducted to this date. In this review, we addressed the following key questions: 1. What implementation strategies are used to implement FPIs in hospitals? 2. At what level are implementation strategies reported following the recommendations of Proctor et al. (2013)? 3. Which implementation strategy or combination of strategies are most effective at promoting the use of FPIs and in reducing fall rates in hospitalized patients? Methods The review protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42018091173). However, we have made some changes to the original review protocol, which are mentioned where appropriate. The systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement [14]. Search Relevant studies were searched in the Embase, Medline (Ovid), Web of Science, CINAHL EBSCO, Cochrane CENTRAL, and PsycINFO databases. A biomedical information specialist of the Erasmus MC Medical Library (WB) guided the search. The search strategy included the terms ‘falls’, ‘incidence’, ‘accidental falls’, ‘adults’, ‘implementation’, ‘strategies’, the full search strategy is presented in additional file I. The initial search was performed from inception until March 2018, followed by several search updates, up until 21th of October 2024. Eligibility criteria and screening Studies that met the following criteria were included: 1) reported at least one implementation strategy for FPI(s) in the hospital setting; 2) reported falls per 1000 patient days; and 3) made a comparison using an experimental randomized or nonrandomized study design. Studies conducted in the emergency room or intensive care were excluded due to incomparability to regular hospital wards, in terms of patient-nurse ratio, risk of falling. All duplicates in EndNote™ were removed using deduplication method described by Bramer et al. [15] Titles and abstracts were screened for eligibility. Reviewers (DS, TL, EI, FH) independently conducted full-text screening and eligibility assessment. Any conflicts were resolved through discussion.
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