Validation of the Electronic Version of the Hester Davis Scale

Amy Hester PhD(c), BSN, RN, Julie Bane, MSN, RN, BC, Jamie Peacock MNSc, RN, CPHQ
This work was supported by grant UL1RR029884 through the NIH National Center for Research Resources and National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Background
The Hester Davis Scale (HDS) was originally implemented and validated in paper format It has now been converted to Purpose electronic format in the Allscripts Sunrise platform The electronic version needed to be validated to ensure continued ability to accurately predict the risk to fall

Methods
A query was created using specific characteristics to retrieve de-identified information from the data repository. This created a report that delivered HDS scores for 1083 patients treated on a medical and a surgical unit during the study period.
Geriatrics Family Prac. Surgery Other

Demographics
Medical Unit (n=510) Medicine 76.9% 10.5% 5.7% 3.7% 3.2% Surgical Unit (n=573) Surgery 52.3% Orthopedics Gynecology ENT Medicine Other 11.8% 11.8% 11.6% 5.7% 6.8%

Findings
HDS Version Paper (n=1904) HDS Cut Score 7 10 Electronic (n=1083) 7 10

Purpose
To use data migrated from the electronic medical record (EMR) data repository to validate the electronic version of the HDS

Thirty one fallers were classified using deidentified data provided by the hospitals Nursing Quality Director. Statistical analysis of this data was performed using SPSS Version 18 and VassarStats.

Sensitivity (95% CI) 100% (89.9% -100%) 90.9% (77.4%-97.0%) 93.5% (77.2%-98.9%) 90.3% (73.1%-97.5%)

Specificity (95% CI) 24.9% (23%-26.9%) 47.1% (44.8%-49.4%) 33.5% (30.6%-36.4%) 64.8% (61.8%-67.7%)

HDS
Note that both versions of the HDS allow the nurse to see both the level of fall risk and also why the patient is at risk to fall so that an individualized approach to falls management can be implemented. The electronic version also allows the nurse to view trends over time.

ROC analysis for a cut score of 10. The Area Under the Curve (AUC) = 0.780 (p= 0.000)

Question
In adult patients in the acute care setting, does use of the electronic version of the HDS compared to use of the paper version of the HDS continue to provide accurate fall risk assessment?

Conclusions
The psychometric performance of the electronic HDS continued to evidence superior predictive ability. Current practice is to implement a fall prevention protocol with a cut score of 7 or greater on the HDS. However, the optimal cut score for the electronic version was 10.