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The 6-PACK programme to decrease falls and fall-related injuries in acute hospitals: protocol for an economic evaluation alongside a cluster randomised controlled trial
  1. Renata Morello1,
  2. Anna Barker1,
  3. Silva Zavarsek2,
  4. Jennifer J Watts2,
  5. Terry Haines3,
  6. Keith Hill4,
  7. Cathie Sherrington5,
  8. Caroline Brand1,
  9. Damien Jolley1,
  10. Just Stoelwinder1
  1. 1The Centre for Research Excellence in Patient Safety, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
  2. 2Centre for Health Economics, Monash University, Victoria, Australia
  3. 3Department of Physiotherapy, Monash University and Allied Health Research Unit, Southern Health, Monash University, Victoria, Australia
  4. 4School of Physiotherapy, Curtin University, Western Australia, Australia
  5. 5The George Institute for Global Health, The University of Sydney, New South Wales, Australia
  1. Correspondence to Renata Morello, Centre for Research Excellence in Patient (CREPS), School of Public Health and Preventive Medicine, Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; renata.morello{at}


Background Falls are a common hospital occurrence complicating the care of patients. From an economic perspective, the impact of in-hospital falls and related injuries is substantial. However, few studies have examined the economic implications of falls prevention interventions in an acute care setting. The 6-PACK programme is a targeted nurse delivered falls prevention programme designed specifically for acute hospital wards. It includes a risk assessment tool and six simple strategies that nurses apply to patients classified as high-risk by the tool.

Objective To examine the incremental cost-effectiveness of the 6-PACK programme for the prevention of falls and fall-related injuries, compared with usual care practice, from an acute hospital perspective.

Methods and design The 6-PACK project is a multicentre cluster randomised controlled trial (RCT) that includes 24 acute medical and surgical wards from six hospitals in Australia to investigate the efficacy of the 6-PACK programme. This economic evaluation will be conducted alongside the 6-PACK cluster RCT. Outcome and hospitalisation cost data will be prospectively collected on approximately 16 000 patients admitted to the participating wards during the 12-month trial period. The results of the economic evaluation will be expressed as ‘cost or saving per fall prevented’ and ‘cost or saving per fall-related injury prevented’ calculated from differences in mean costs and effects in the intervention and control groups, to generate an incremental cost-effectiveness ratio (ICER).

Discussion This economic evaluation will provide an opportunity to explore the cost-effectiveness of a targeted nurse delivered falls prevention programme for reducing in-hospital falls and fall-related injuries. This protocol provides a detailed statement of a planned economic evaluation conducted alongside a cluster RCT to investigate the efficacy of the 6-PACK programme to prevent falls and fall-related injuries.

Trial registration number The protocol for the cluster RCT is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000332921).

  • Accidental falls
  • hospital care populations/contexts
  • economic evaluation
  • cost-effectiveness
  • randomised trial methodology
  • older people populations/contexts
  • clinical care interventions
  • fall
  • clinical care
  • mixed methods
  • hospital care
  • public health

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  • Funding National Health & Medical Research Council, Australia (APP1007627).

  • Competing interests None.

  • Patient consent This study is a cluster randomised controlled trial. As such hospital wards and not individual patients have been recruited to this study.

  • Ethics approval Multicentre approval has been granted by Monash University Human Research Ethics Committee (project number: CF11/0229: 2011000072). Site-specific ethics and research governance approval has also been obtained from local ethics committees at all participating hospitals.

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