What is the Impact of Centralised Versus Decentralised Ward Designs on Fall Incidences in One Older Adult Mental Health Inpatient Unit in Victoria, Australia

Synopsis

This study examines the impact of ward design on falls incidence in older adult mental health inpatient care, with a focus on Australia’s emerging shift from centralised to ‘decentralised / pod’ ward models. In line with national goals to reduce restrictive practices and enhance person-centred care, decentralised ward layouts—often pod-based with segmented visibility—are becoming the new standard in older adult mental health services. While these environments aim to enhance therapeutic engagement and patient satisfaction, their implications for patient safety, particularly falls, remain under-explored.
Adopting a convergent mixed methods design grounded in pragmatism, this study triangulates quantitative incident data with qualitative insights from nursing staff to gain a comprehensive understanding of how physical ward design influences falls incidence and other aspects of mental health nursing such as visual observations. Quantitative data on falls incidents, extracted from the hospital’s RISKMAN system, will be analysed pre- and post-relocation (six months either side) from a centralised to a decentralised ward. Key variables include time, location, severity, witnessed vs unwitnessed falls, and falls risk (FRASS scores).
Complementing this, semi-structured interviews with up to 12 nursing staff—each having experienced both ward layouts—will explore their perceptions of how design impacted workflow, visibility, and fall prevention practices. Analysis will use Braun and Clarke’s reflexive thematic analysis, informed by Bridges’ Transition Theory to contextualise staff adaptation to environmental change.
Findings aim to inform future ward design in mental health, bridging clinical practice, service user safety, and environmental planning.