Development and validation of interpretable machine learning models for inpatient fall events and electronic medical record integration

OBJECTIVE: Falls are one of the most frequently occurring adverse events among hospitalized patients. The Morse Fall Scale, which has been widely used for fall risk assessment, has the two limitations of low specificity and difficulty in practical implementation. The aim of this study was to develop and validate an interpretable machine learning model for prediction of falls to be integrated in an electronic medical record (EMR) system. METHODS: This was a retrospective study involving a tertiary teaching hospital in Seoul, Korea. Based on the literature, 83 known predictors were grouped into seven categories. Interpretable fall event prediction models were developed using multiple machine learning models including gradient boosting and Shapley values. RESULTS: Overall, 191,778 cases with 272 fall events (0.1%) were included in the analysis. With the validation cohort of 2020, the area under the receiver operating curve (AUROC) of the gradient boosting model was 0.817 (95% confidence interval [CI], 0.720–0.904), better performance than random forest (AUROC, 0.801; 95% CI, 0.708–0.890), logistic regression (AUROC, 0.802; 95% CI, 0.721–0.878), artificial neural net (AUROC, 0.736; 95% CI, 0.650–0.821), and conventional Morse fall score (AUROC, 0.652; 95% CI, 0.570–0.715). The model’s interpretability was enhanced at both the population and patient levels. The algorithm was later integrated into the current EMR system. CONCLUSION: We developed an interpretable machine learning prediction model for inpatient fall events using EMR integration formats.