Investigation of High Efficacy Groups for Hospital‐Wide Standardized Hypnotic Bundles on Insomnia: A Subgroup Analysis of the COBATON Study

Introduction In a previous study, a reduction in hypnotic‐related fall and injury incidence rates was revealed after the hospital‐wide standardization of hypnotic bundles for insomnia. Subsequently, a subgroup analysis was conducted to identify high‐efficacy groups for new hypnotic bundles. Methods Total fall rates, hypnotic‐related fall rates, and injury incidences before and after standardization of the new bundle were analyzed using seven subgroups: sex, age > 75 years, stroke, pneumonia, heart failure, fragility fractures, and dementia. Information on patients who fell, excluding pediatric patients, was collected from the Saitama Citizens Medical Center database. Results No subgroups with reduced fall rates were identified after standardization. Hypnotic‐related fall rates were reduced after the standardization in males (incidence risk ratio [IRR]: 0.65, 95% confidence interval [CI]: 0.51–0.84) and those > 75 years old (IRR: 0.68, 95% CI: 0.54–0.85). Conclusions Hospital‐wide efforts to standardize hypnotic bundles for insomnia may be more useful than efforts for a limited group. Even with interprofessional work, effective fall prevention practices can be challenging. Efforts to manage the risk of falls may shift to trauma prevention hospital‐wide actions.