Evidence map›Paper›PMID 34969050›Full record

ArticlePloS one2021

Disinvestment in the presence of uncertainty: Description of a novel, multi-group, disinvestment trial design and protocol for an application to reduce or cease use of mobilisation alarms for preventing falls in hospitals.

Terry P Haines, Mari Botti, Natasha Brusco, Lisa O'Brien, Bernice Redley, Kelly-Ann Bowles, Alison Hutchinson, Debra Mitchell, Joanna Jellett, Kate Steen and 10 more

Open access · goldAbstract readClinical Trial Protocol
In one paragraph

Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.2field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 10 institutions in 2 countries.

Terry P HainesSchool of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, Australia.ORCID 0000-0003-3150-6154
Mari BottiSchool of Nursing & Midwifery, Deakin University, Geelong, Australia.
Natasha BruscoRehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
Lisa O'BrienDepartment of Occupational Therapy, Monash University, Melbourne, Australia.
Bernice RedleyCentre for Quality and Patient Safety Research-Monash Health Partnership, Melbourne, Australia.
Kelly-Ann BowlesDepartment of Paramedicine, Monash University, Melbourne, Australia.ORCID 0000-0002-5965-5971
Alison HutchinsonCentre for Quality and Patient Safety Research-Monash Health Partnership, Melbourne, Australia.
Debra MitchellAllied Health Workforce, Innovation, Strategy, Education and Research (WISER) Unit, Monash Health, Clayton, Australia.
Joanna JellettFalls Prevention Service, The Mornington Centre, Peninsula Health, Victoria, Australia.
Kate SteenEpworth HealthCare, Richmond, Australia.
Leanne BoydChief Nursing and Midwifery Officer, Executive Director Learning and Teaching, Eastern Health, Richmond, Australia.
Melinda Webb-St MartEastern Health, Richmond, Australia.
Melissa RaymondPhysiotherapy Department, Alfred Health, Melbourne, Australia.
Peter HunterGeriatric Medicine, Alfred Health, Melbourne, Australia.
Phillip RussoSchool of Nursing & Midwifery, Monash University, Melbourne, Australia.
Rachel BonniciSchool of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, Australia.
Dai PuSchool of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, Australia.ORCID 0000-0002-6268-4378
Samantha SevenhuysenPeninsula Health, Frankston, Australia.
Vicki DaviesSubacute Ambulatory Care Manager Peninsula Health, Frankston, Australia.
Ronald ShorrGeriatric Research Education and Clinical Center, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida.
Monash University · AUDeakin University · AUPeninsula Health · AUEastern Health · AUAlfred Health · AUCabrini Hospital · AUEpworth Hospital · AULa Trobe University · AUMonash Health · AUUniversity of Florida · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Disinvestment is the removal or reduction of previously provided practices or services, and has typically been undertaken where a practice or service has been clearly shown to be ineffective, inefficient and/or harmful. However, practices and services that have uncertain evidence of effectiveness, efficiency and safety can also be considered as candidates for disinvestment. Disinvestment from these practices and services is risky as they may yet prove to be beneficial if further evidence becomes available. A novel research approach has previously been described for this situation, allowing disinvestment to take place while simultaneously generating evidence previously missing from consideration. In this paper, we describe how this approach can be expanded to situations where three or more conditions are of relevance, and describe the protocol for a trial examining the reduction and elimination of use of mobilisation alarms on hospital wards to prevent patient falls. Our approach utilises a 3-group, concurrent, non-inferiority, stepped wedge, randomised design with an embedded parallel, cluster randomised design. Eighteen hospital wards with high rates of alarm use (≥3%) will be paired within their health service and randomly allocated to a calendar month when they will transition to a "Reduced" (<3%) or "Eliminated" (0%) mobilisation alarm condition. Dynamic randomisation will be used to determine which ward in each pair will be allocated to either the reduced or eliminated condition to promote equivalence between wards for the embedded parallel, cluster randomised component of the design. A project governance committee will set non-inferiority margins. The primary outcome will be rates of falls. Secondary clinical, process, safety, and economic outcomes will be collected and a concurrent economic evaluation undertaken.

Indexed as

Accidental FallsClinical AlarmsHospitalizationHospitalsMonitoring, AmbulatoryPatient SafetyBedsComputer SimulationElectronics, MedicalHumansMulticenter Studies as TopicOutcome Assessment, Health CareRandomized Controlled Trials as TopicResearch DesignStatistics as TopicUncertainty

Identifiers

PMID34969050
PMCPMC8717976
OpenAlexW4200120508

What OpenQuestion holds

Textmetadata
LicenceCC0
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.