Technology for Patient’s Fall Detection System in Hospital Settings: A Systematic Literature Review

: The prevalence of falls among patients in hospitals around the world is still relatively high. Technology is needed to detect the incidence of patients falling in hospitals. The aim of this study is to analyze technology to detect patient fall in hospital settings. A systematic literature review was chosen as the research design. The databases used to search for literature include Google Scholar, Science Direct, PubMed, and Springer using keywords combined with Boolean operators. The selection of articles is based on several criteria including the publication year 2017-2021, full-text articles, the research setting in a hospital, articles in English, and articles that used research design qualitative, quantitative, and mix-method. The Articles found according to the criteria were 13 articles. The findings showed that there are two types of technology found in this review which are wearable devices and ambient sensor devices. Most of the technical procedure is by connecting the technologies with a wireless network and uploading the data to the server and only a few technologies measure directly. This review also found the advantages and disadvantages of these two types of technology. The health service provider can choose technology by considering the results of the analysis that has been carried out by considering the type of technologies, working procedures, advantages, and disadvantages of the technology so the health service provider can choose the appropriate technology in the hospital.


INTRODUCTION
Patient safety is a system that makes patient care safer, including risk assessment, patient risk identification and management, incident reporting and analysis, the ability to learn from incidents and their follow-up, as well as implementing solutions to minimize risks and prevent injury caused by an error due to carrying out an action or not taking the action that should have been taken (Permenkes, 2017).Patient safety is a fundamental principle in the implementation of health care (Salawati, 2020).A few countries have published studies showing that the number of patients who are harmed during the treatment process has an impact on the longer the patient will be hospitalized.In addition to causing harm to the patient himself, the impact of not enforcing patient safety in the hospital will also have an impact on the hospital as a provider of health care services (Morse, 2008).This is because the value of patient satisfaction with health services is the main component of a quality hospital (Rahmawati, Ardiana, & Kurniawan, 2020).
Many factors are at risk of endangering patient safety in hospitals.One of the things included in patient safety that needs to be considered is the incidence of patient falls.According to the World Health Organization (WHO) (2007) found unwanted events where one of them is the incidence of patients falling with an incidence range of 3.2-16.6% of the total patients in hospitals in hospitals in various countries, namely America, England, Denmark, and Australia (Susanti, 2016).In addition to experiencing physical losses, the incident of a patient falling will also increase hospital costs.While in Indonesia itself, in 2012, it was reported that the incidence of patient falls was included in the top three hospital incidents and was in the second level after medicine errors.This still needs to be added to the Joint Commission International (JCI) standard, which states that patient falls are not expected to occur in the hospital (Nur, Dharmana, & Santoso, 2017).
The incidence of patient falls was an important issue to be discussed in more depth.Because the incidence of patients falling in the hospital resulted in a lot of losses.For patients themselves, falling incidents can result in injury or injury to the patient's body, especially if the patient experiences a fatal fall, it will be dangerous to the patient's health (Dewi et al., 2018).One of the impacts of falls for patients is physical injury consisting of abrasions, lacerations, and bruises; even in some severe cases, falls experienced by patients can cause fractures, bleeding, and head injuries.In addition to having an impact on patients, the incidence of falling patients also has an impact on hospitals, where the occurrence of falling patients gives the hospital will get a bad image by the community or patients and will have an impact on the sustainability of the health service process itself (Marpaung, 2019).
Previous studies related to technology to detect falling patients have been carried out and have even been applied in several hospitals in various parts of the world.The types of technology that have been applied include sensor-and camera-based technology that can detect patients experiencing falling incidents (Marpaung, 2019).There need to be studies that specifically discuss the types of technology, technology work procedures, and advantages and disadvantages of fall detection technology in detail.This signifies a research gap that the researchers aim to address by conducting a literature review to identify fall patient detection technology in hospitals, including types of technology, technology work procedures, and advantages and disadvantages of fall detection technology in the hospital.

METHOD
This study used the systematic literature review method.The articles that have been collected are read carefully then summarize, draw conclusions, and find gaps in the manuscript that are adapted to the topic and research question (Ulhaq & Rahmayanti, 2019).The databases used in this literature review include PubMed, Science Direct, Google Scholar, and Springer.All databases were accessed by the researchers on April 4, 2022.In the literature search, the keywords used were combined with Boolean Operators, which aims to expand or make the literature search more specific.The keywords were (detection OR observation) AND (technology OR tools) AND (patient OR client) AND (fall OR accident).From the results of article research through four databases with the aid of Boolean Operators, the researchers found 2.322.567articles that matched these keywords, consisting of 2.171 articles in PubMed, 139.574 articles in Science Direct, 822 articles in Springer, and 2.180.000articles in Google Scholar.After being excluded based on the inclusion and exclusion criteria, 13 articles were included in the analysis.
This systematic literature review used the following inclusion criteria: 1) the article was published in 2017-2021; 2) the study was conducted in a hospital setting; 3) articles were written in English; 4) the research was available in the full-text article; 5) research design is quantitative, qualitative, or mixed methods.Types of research include cross-sectional studies, diagnostic test accuracy studies, cohorts, quasi-experimental, case-control, or randomized control trials.The exclusion criteria were: 1) the article was published before 2017; 2) the article is not full text.; 3) the The results of the literature analysis found related to the types of technology to detect patient falls in the hospital, the working procedures of the technology, the advantages and disadvantages of the technology.

DISCUSSION
Further explanation regarding the indicators that have been mentioned as follows:

Types of Technology for Fall Detection in Hospitals
The types of technology to detect patients falling in hospitals are divided into two, namely the type of technology that can be worn by the patient or commonly called wearable devices and the type of technology that is not worn directly by the patient or ambient sensors devices (Rajagopalan, Litvan, & Jung, 2017).The following types of technology are used: a. Wearable devices The type of patient fall detection technology based on wearable technology or wearable devices consists of two tools, namely an accelerometer which is useful for measuring the acceleration or acceleration of an object (Hardjianto, Rony, & Trengginas, 2016).And a gyroscope that is useful for tracking the rotation or rotation of an object based on motion.The gyroscope is able to read the direction of a movement when experiencing an acceleration (Arifien, Bachtiar, & Yudistira, 2021).The tools found in this research process that combine the two technological components above include the smart walking cane, INBED, and Apple watch.b.Ambient sensor devices The types of technology used in the ambient fall detection system include camera-based and proximity sensors.camera-based sensor, which is a type of camera-based fall detection technology that is supported by other supporting sensors such as infrared sensors, night vision sensors, and sensors that can penetrate glass usually this technology is connected directly to a computer that can directly send the captured images to the server (Melita, Bhaskoro, & Subekti, 2018).The analysis of the article found tools that use camera-based technology, including HELPER and camera-based technology that can penetrate glass, rain and transparent screens.The second is Proximity Sensors which is a tool that can detect the distance of an object to the sensor.Proximity sensors can detect motion information and the presence of an object or object and turn it into an electrical signal (Koyama, Shimojo, Senoo, & Ishikawa, 2018).But in the process of analyzing the article no tools were found that use this technology in its operation.

Technology Working Procedures Used to Detect Falling Patients in Hospitals
The application of the technology in a fall patient detection system, usually the accelerometer and gyroscope used will be integrated with a data transmitter connected to the internet so that data from falls detected by the accelerometer will be directly sent via the internet to the health service provider so that the health service provider can monitor patients remotely (Faluzi, Machmud, & Arif, 2018).In the article that has been analyzed, it is found that the working principle of the accelerometer is more or less the same as the explanation described above, but differences are found in the technology that uses ordinary accelerometers and three-axis accelerometers where ordinary accelerometers can only recognize changes in acceleration in certain directions while three-axis accelerometers can recognize changes in acceleration.change in the acceleration of an object in three different directions.
The camera-based patient fall detection system works like a camera in general, but the camera to detect falling patients is equipped with a sensor that can detect the movement of the subject being observed so that due to the sensor, the system will detect that the subject has fallen, not only that the system The camera-based fall patient detection will be equipped with a computer to process the images from the camera (Jian et al., 2017).This system is usually also connected to the internet so that data from direct camera observations can be sent directly to the health service provider so that the patient's fall can be taken immediately.

Advantages and Disadvantages of Technology to Detect Falling Patients in Hospitals
The accelerometer has advantages in its use, such as the price of this tool is affordable so that this tool is widely used in patient fall detection systems.In addition, the advantage of this tool is that the measurement results are considered accurate, especially when the system is at rest or static (Anggunadi & Sutarina, 2017).The gyroscope also has several advantages, the advantages of the gyroscope itself include the measurements made by this gyroscope are not affected by gravity, besides that the gyroscope can also detect movement from all directions and the images and movements produced from this gyroscope are also smoother than the motion images produced by the gyroscope.generated by the accelerometer (Nurhafizah, Fajrin, & Kartika, 2022).
Although it has several advantages that have been mentioned above, the accelerator also has several disadvantages, including the response of this tool tends to be slow; high-power consumption makes this tool tend to waste battery.Similar to accelerators, although they have many advantages, gyroscopes also have several disadvantages, they are relatively expensive, and the gyroscope will function optimally when combined with an accelerometer so that this tool will not produce maximum results when used without being combined with an accelerometer (Sun, Zang, Gravina, Fortino, & Li, 2020).In addition, the drawback of a wearable fall patient detection system is that the device is generally less comfortable to use because it interferes with the mobility of the patient, besides using the device for a long time will result in injuries and bruises to the patient (Rajagopalan et al., 2017).
The camera-based fall detection system has several advantages; among others, this system can detect objects that are observed at all times as long as the object is still within reach of the camera.tools contained in the body (Coahran et al., 2018).The camera-based patient fall detection system can also reveal the cause of the patient's fall.In addition to having some of the advantages already mentioned, the camera-based fall detection system also has several weaknesses, including the lack of patient privacy, because the patient will be monitored and observed all the time so that the patient will feel that his privacy is disturbed.In its application, this system usually uses a camera with the latest technology, and this tool is also classified as consuming large amounts of power because this tool continuously monitors patients without stopping (Arifien et al., 2021).
The analysis of the selected articles resulted in some of the points discussed above, although this research has several limitations, including incomplete database features, no articles sourced from the Springer database because they need to meet the requirements, and less specific keywords resulting in searches being wide.The results of this literature review are expected to be used as guidelines for the use of patient fall detection tools in hospitals so that nurses can detect falls experienced by patients without having to monitor patients continuously and nurses only need to monitor at the nurse station.In addition, with the technology described in this literature review, it is hoped that the handling of falls in patients can be faster and more precise.

CONCLUSION
This systematic literature review concludes that the types of technology used to detect falls in hospitals are divided into two parts, namely wearable devices, and ambient-based sensors.The working procedure from devices that are worn directly by the patient or devices that are not worn directly by the patient that is, the device is equipped with data transmission technology via an internet-based network that is directly connected to the health service provider's device or by sending a warning signal to the server regarding the incident falls experienced by the patient.This type of wearable device-based technology has advantages, in general, is patient privacy is maintained and has disadvantages patients feel uncomfortable when wearing it for a long time, while ambient-based sensor technology has the advantage that patients feel comfortable because they do not use technology directly and the disadvantage patient privacy will be disturbed because patient feels watched all the time.