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Patient falls in hospitals: An increasing problem



Despite six decades of worldwide efforts that include publishing virtually hundreds of related epidemiological-type studies, there has been an increase (estimated to be 46% per 1000 patient days from 1954-6 to 2006-10) in the number of patient falls in hospitals and other health care facilities. These still occur most frequently near the bedside or in the bathroom, among mentally confused or physically impaired patients, and often involve those with greater comorbidity. The reasons that hospitals during the past half century have demonstrated a significant increase in patient falls per discharge or per patient days are numerous, are not completely surprising, and are certainly interrelated: improved accident reporting systems; on the average older, more impaired, more acutely ill, and more heavily sedated patients; and, less time spent by nursing personnel at the bedside. Most safety committees are not as effective as they should be, since they have difficulty in implementing a long-term, aggressive, facility-wide prevention program. Within that context, it may be worthwhile to discuss the advantages of nursing leadership rather than a representative of the facility's management staff to chair these safety committees. Copyright © 2015 Elsevier Inc. All rights reserved.
7/23/155 Accepted for publication in “Geriatric Nursing,”
Thomas P. Weil, Ph.D.*
* President Emeritus, Bedford Health Associates, Inc., Management
Consultants for Health and Hospital Services, Katonah, N.Y., and
Asheville, N.C (1975-2001). Contact Info: 1400 Town Mt. Road,
Asheville, N.C. 28804; 828-252-1523; FAX: 828-253-3820.
Despite six decades of worldwide efforts that include
publishing virtually hundreds of related epidemiological-type
studies, there has been an increase (estimated to be 46% per 1,000
patient days from 1954-6 to 2006-10) in the number of patient
falls in hospitals and other healthcare facilities. These still
occur most frequently near the bedside or in the bathroom, among
mentally confused or physically impaired patients, and often
involve those with greater comorbidity. Where there might be a
break thru is that there is some evidence that patients receiving
benzodiazepines are significantly more prone to incur a fall. The
reasons that hospitals during the past half century have
demonstrated a significant increase in patient falls per discharge
or per patient days are numerous, are not completely surprising,
and are certainly interrelated: improved accident reporting
systems; on the average older, more impaired, more acutely ill,
and more heavily sedated patients; and, less time spent by nursing
personnel at the bedside. Conversely, patients are better served
with greater nurse staffing ratios since they tend to reduce the
number of patient accidents. Most safety committees are not as
effective as they should be, since they have difficulty in
implementing a long-term, aggressive, facility-wide prevention
program. Within that context, it may be worthwhile to discuss the
advantages of nursing leadership rather than a representative of
the facility’s management staff to chair these safety committees.
Key words: Patient falls; hospital safety committees.
Over the past six decades, patient falls have been the focus
of literally hundreds of published studies, each one of them
focusing on acute and other healthcare facilities becoming safer
environments. This half-century is generally considered history-
ically to be an unusually productive period where western
industrialized nations have experienced significant enhancements
in the medical sciences; and, as a result of these advances, major
modifications were needed and then implemented on how providers
are to be reimbursed by third-party payers. Therefore, the
question arises: In this “new environment,” why has the vast
number of epidemiological studies of patient falls not led the way
to significantly fewer discharges without a prior incident?
In the mid-1950s, there were just a few studies of patient
falls in the literature.(1-3) Since then numerous reports have
been published around the world spanning Australia,(4) Canada,
(5)Israel,(6) Italy,(7) Spain,(8) Switzerland,(9) Taiwan, (10) and
the United Kingdom (U.K.).(11-12) If you review the references of
just one American(13) and one U.K.(14) paper, it is easy to
conclude that since the mid-1950s, virtually hundreds of such
studies have been added to the literature. Certainly this
suggests that patient falls is a topic that has generated
considerable interest particularly among physicians and nurses,
who want to assure the public that their healthcare facilities
offer a safe environment where they receive quality patient care.
Unfortunately, inpatient falls are relatively common, some
of them considered avoidable, and only a few of them resulting in
a serious injury and a prolonged hospital stay. It is in this
context of assuring patients in various healthcare facilities of
improved safety, that the purposes of this paper are to analyze:
(a) whether during the last six decades their incidence per
discharge or patient days has decreased or not; (b) whether the
pattern of patient accidents has significantly changed, and if so
how?; and, (c) what still needs to be accomplished to make our
healthcare facilities a safer environment? A proposed outcome of
all these efforts should obviously be fewer patient falls as the
employees of various healthcare facilities became better informed
about their causation.
Some Findings in the 1950s Compared to Today
To undertake an analysis of patient falls in the 1950s
compared to more recently, some annual accident rates reported in
the literature have been selected for review at the outset for
According to the incident reports (most often nurses filling
out a special form by hand) at Mount Sinai Hospital (New York
City) during the years 1954 through 1956, there were 2,036 patient
falls. (1) There were 70,048 admissions to the hospital during
the three years included in this study, suggesting an accident
rate of 28.5 incidents per l,000 patient admissions or 2.5
accidents per 1,000 patient days. These rates compared favorably
with Williams’ findings (1947) (2) at the University of Illinois
Hospital and are consistent with a survey of a group of British
hospitals after World War II. (3)
Over the last several decades, there have been a significant
number of studies (rarely providing average length of stay)
focusing on the incidence of hospital patient falls and offer
these findings:
a. Reported were 18.4 patient accidents per l,000
admissions during a twenty-two month period (1981-82) in a study
based in a U.S. 152-bed acute specialty hospital;(15)
b. Reported were the rates of falls per 1,000 admissions in
the psychiatric, elder care, and rehabilitation departments in
1998 in a 2,000 bed Israeli teaching hospital and they were
significantly higher than in an earlier period (1978-81). (16)
Rates of 115, 91, and 85, respectively, per 1,000 admissions were
cited in 1998 compared with 34, 9, and 19, respectively, in the
1978-81 period. The percentage of reported falls in the young age
group (under 50 years of age) was also significantly higher in the
1998 survey;
c. Reported in fiscal year 2000 were 75.0 incidents per
1,000 admissions, after randomly selecting one teaching, one large
community, and two small community hospitals in five Canadian
provinces; (5)
d. Reported were 2.63 falls per 1,000 patient days based on
a study from 1997 to 2002 in an U.S. academic acute care hospital;
e. Reported were 7.5 falls per 1,000 admissions in a 300-
bed urban public hospital in Switzerland from 1999 to 2003.(9)
There were huge differences in rates per 1,000 admissions by
service: geriatrics 24.8; internal medicine 8.8; and, surgery 1.9;
f. Reported were 3.l falls per 1,000 patient days during
January 2001 through June 2002 at a large U.S. academic teaching
hospital; (18)
g. Reported were hospital patient accidents of 4.4 per
l,000 patient days in 2002 in Taiwan;(10)
h. Reported were findings from a study undertaken in the
U.K. from September 2005 through August 2006 of almost 500
institutions (a mix of acute hospitals, community hospitals, and
mental health units), the mean standardized rates of falls per
1,000 patient days were 4.8 in acute hospitals, 2.1 in mental
health units, and 8.4 in community hospitals; (11) and, finally,
i. Reported was a mean fall rate of 3.65 per 1,000 patient
days during a 54-month period (July 2006-December 2010) in a
longitudinal study with a sample of 1,524 hospitals participating
in a National Database for Nursing Quality endeavor. (19)
Although there is significant fluctuation among the above findings, one should conclude
that over the last half century that hospitals and other healthcare facilities have generally
experienced an increase in the number of patient falls per 1,000 admissions or days. If you
compare the 1954-56 Mount Sinai Hospital data (1) to a broad-based study a half century
later,(19) it is estimated that there has been a 46% increase in patient falls per 1,000 patient days.
The probable reasons are voluminous and are discussed later.
High-Risk Factors Related to Patient Falls
There are several repeating themes, whether it was in the
1950s or most often replicated recently, that either delineate key
factors or describe specific-types of patients who most frequently
experience falls. In fact, there has been minimal changes over
the last half century in the profile of the patient who frequently
has an incident. It is critical to study these somewhat distinct
variables, all of them needing to be considered when developing a
sound patient safety program for any healthcare facility:
a. A few key variables in studying patient accidents. The
Mount Sinai Hospital study (1) using mid-1950 data found that
twice as many falls occurred among males as females. But more
critical is the incident rate among patients admitted to a ward (a
Florence Nightingale-type accommodation of six or more patients in
one room) was 34.9 per 1,000 admissions as compared to a rate of
28.6 for semi-private (usually a two-bedded room), 10.4 for
private (a single occupant), and 5.7 for obstetrical patients.
Noteworthy, the very young and the old had the most accidents even
when adjusted for days of patient exposure. Fortunately, 90% or
more of hospital falls resulted in “no detectable” or a “slight
injury,” and less than 5% resulted in a serious trauma.
b. Time of day for most falls. Is nighttime, when less
personnel is around, the period of more frequent patient falls?
Contrary to general opinion, more accidents occurred at Mount
Sinai Hospital during the day shift than at any other time.(1)
Most bedside falls, a result of patients getting out of or
returning to bed, however, happened at night. This may be
explained by the fact that more patients are in bed at night,
fewer personnel are on the floors, and darkness may be a
psychological cause during these hours.
c. Cognitive factors. An Australian study (4) in large
Melbourne teaching hospital reported that the Diagnosis Related
Group (DRG) with the highest proportion of falls (24%) was
“dementia and other disturbances of cerebral function;” and, these
patients had a significantly longer average length of stay and a
higher cost per discharge. These findings replicate the earlier
Mount Sinai Hospital study (1) where patients with neurologic,
psychiatric, and orthopedic diagnoses on admission were involved
in significantly more incidents than expected.
d. Patients who have one fall are prone to experience
another soon thereafter. There is reasonably solid evidence(1, 9,
11, 15 ) that if a patient has one fall there is more than a
reasonable chance they will soon thereafter have another. During
the three-year study at Mount Sinai Hospital, (1) roughly ten
percent (9.7%) of the patients having an accident accounted for
23.3% of the all the falls included in the study. Approximately
half of the repeated falls occurred within five days of the first
These findings were repeated in a 152-bed acute hospital
study during 1981-2 (15), where patients that had fallen once had
a subsequent fall rate of 91.7 per 1,000 admissions compared to an
overall rate of 18.7 for first falls. Half of all these falls
occurred in or in route to a private bathroom that was part of the
patient room. The trend toward private rooms with baths and
greater emphasis on patient ambulation may have simultaneously
increased exposure to accidents to, in, and back from a bathroom.
What needs some further study is whether the current trend of
patients maintaining function and physical activity is a major
factor in these repeated accidents?
e. Location of patient accidents. In the Mount Sinai Hospital
study (1), the most falls occurred at the bedside (61.0%); in the
bathroom (11.5%); in the hallway (11.1%) and, in the outpatient
department (3.1%). It is estimated that 65% of all patient falls
occurred in the patients' rooms or in wards within a 10 foot
radius of the patient’s bed. These early findings of where falls
arise most frequently were replicated in a number of more recent
studies. (9, 15, 16)
f. Most falls result in minor injury. In a study (9)
conducted in a 300-bed urban, public hospital in Switzerland from
1999 to 2003, two-thirds of the patients who fell sustained no
injury. In 30.1% and 5.1%, respectively, minor and major injuries
were observed. Not surprisingly, there was a twofold increase in
the proportion of patients in the geriatric department who
experienced major injuries compared to the department of internal
medicine. The overall evidence suggests that the patient who has
impaired mobility and impaired cognition, including disorientation
and confusion, is far more likely to be subject to a serious fall.
g. Impact of a safety committee. Enloe et al. (17) provides
a particularly interesting study in the sense that it traces the
incidence of falls in a 471-bed academic health center over a six-
year period (1997-2002), while simultaneously underway was an
ongoing internally-organized accident prevention program. The fall
rates decreased (3.6%/annum), but the decline was almost solely
attributed to one department. Psychiatry had the most significant
decline in fall rate over time, likely influenced by new
medications with fewer side effects, a change in patient
orientation on admission, and continuing safety education for
staff. This institution’s long-term results are consistent with
Dempsey’s evaluation (20) that a fall prevention program five
years after implementation showed that the gains made in decreases
in falls in the first year were not sustainable over time.
h. Probably the key variable. A study (2002-3) in a 323-bed
teaching hospital in Melbourne, Australia confirms earlier
findings in that the DRG with the highest proportion (24%) of
patient falls was “dementia and other chronic disturbances of
cerebral functions.”(21) Particularly noticeable with a high
percentage of falls, longer average lengths of stay, and higher
patient costs were those with the DRG of “stroke with
severe/complicating diagnosis and procedure.” It is obvious that
healthcare facility accident prevention programs need to focus on
patients with these types of diagnoses.
Impact of Drugs on Patient Falls
As early as 1936, Haigh and Hayman (22) suggested that
sedatives, especially phenobarbital, might be a factor in patient
falls. In the Mount Sinai Hospital study, (1) sedatives,
narcotics, stimulants, and other drugs were considered factors in
only 5% and anaesthetics in 3% of the cases. A detailed review of
each patient’s chart involved in a fall, rather than mostly
relying on the incident report that most frequently was completed
by a nurse who was most interested in describing the accident and
condition of the patient, might have resulted in a more accurate
There is growing evidence based on studies published during
the last two decades that patients taking one or more
benzodiazepines (very often temazepan), most frequently prescribed
to enhance sleeping at night times, have increased the risk of
falling near the bedside. (22) Another study (14) noted that a
significant fall risk factor is a prescription of “culprit drugs”
(especially sedatives/hypnotics) in combination with gait
instability, agitated confusion, and urinary incontinence/
Frels et al. in a 2002 U.K. study (23) found that 46% of
those who had an incident were taking one or more benzodiazepines
compared with 27% of the control patients. Temazepam was the main
benzodiazepine used by over 95% of cases and controls. Falls were
least likely to occur during visiting hours with a peak incidence
during night time. For safety reasons, it was recommended that
finding an alternative to benzodiazepines for night sedation for
older patients needs to be sought. (24)
Financial Impact
In a 2004-06 study (25)at a three-hospital mid-western (U.S)
health care system, 57 patients experienced a serious fall
related injury (fracture, subdural hematoma, any injury resulting
in a surgical intervention or death) with a cost ranging from
$5,808 to $29,450 and on the average, the patient remaining in the
hospital for an additional 6.9 days.
For legal reasons, there is a resistance to publish the
fiscal impact of patient falls. But it must be significant
considering that there were probably 724,000 patient accidents
annually and about 2,500 being serious calculated by simply
multiply an accident rate of say 20.0 accidents/1,000 admissions
(a very low rate)times the 362.2 million inpatient admissions to
U.S. hospitals in 2012.
Prevention Approaches
Almost all hospitals and other healthcare facilities have
some form of safety committee often chaired by a member of the
institution’s executive staff with representatives from nursing,
housekeeping, food service, plant operations, and other
departments. Oliver et al. (26) in 2000 analyzed the then
published hospital fall prevention programs to determine whether
or not they had any favorable impact on preventing falls. They
decided that these committees reduced fall rates in the 9% to 12%
range. A somewhat later study (27) offered no conclusive evidence
that hospital prevention programs reduced the number of falls. The
most recent study concluded that these safety committee efforts
decreased the number of falls by 14%. (29)
Although these safety committees to date have not achieved a
compelling long-term reduction in patient accidents, the themes
that appear to be pertinent to be successful in reducing falls
focuses on: “leadership support, engagement of front-line staff in
program design, guidance of the prevention program by a multi-
disciplinary committee, pilot-testing interventions, use of
information technology systems to provide data about falls, staff
education and training, and changes in nihilistic attitudes among
fall prevention.”(28)
Reasons for More Falls Being Reported
There are a significant number of reasons why patient fall
rates in hospitals and in other healthcare facilities have
increased, even though more data have been collected and analyzed
in the past half-century concerning who, why, and where these
accidents occurred. In addition, almost every one of these
facilities has an active safety committee that attempts to curtail
these incidents. Some reasons why they are experiencing and
reporting more patient falls, and some approaches that might be
used by safety committees to reduce these numbers follow:
a. Improved reporting systems and their analysis. Falls and
related injuries are the most frequently reported adverse event
among adults in hospital settings. As a result, the facility’s
nursing administration philosophy toward what constitutes a
patient accident is so critical and may be more consequential than
the actual process utilized to report such occurrences. The
nursing department’s view of when a fall should be reported or not
must be widely understood in the organization. Also, the details
to be included in the incident reporting process (may be “on line”
or a separate form) is important in terms of future study
In the last half century, the reporting approach in
healthcare facilities has improved and might ideally include what
Donabedian(30) called the structural, process, outcome, and
balancing measures to gain an overview as well as a detailed
account and impact of the patient fall. It is obvious that such
improved data collection should result in higher rates of patient
accidents for the facility as well as improving the data
collection so developing better accident prevention strategies
will be achieved, with the anticipation that these steps should
eventually reduce the number and the severity of falls.
Patient fall studies, including their rates per admissions/
days, are probably influenced by variables: Are all accidents,
incidents, and falls at your healthcare facility reported on the
same form? Or, does a patient fall require that a physician or a
nurse fill out a form that is used exclusively for a patient fall?
Are these incidents reported preferably by asking specific
statements rather than raising questions? And, are they processed
“on line” (included in an electronic health record) rather than on
a special form filled out by hand? Are falls documented only in
the patient’s chart or also via an incident report?
Suspect no one really knows which of these alternatives work
most effectively, but a special fall-accident report submitted “on
line” that encourages the responsible person for the input to
respond to the specific variables outlined by Donabedian (30) and
those contained in this paper would probably be most helpful when
studying current and deterring future falls. In fact, a user
friendly accident reporting system might tend to increase the
number of patient falls reported.
Because of all the variables outlined above in each
hospital’s reporting system, it is doubtful whether inter-
institutional comparisons of patient fall rates are particularly
meaningful. This suggests that the discussion early in this paper
related to incidence rates might be more meaningful in terms of
historical and descriptive for one institution rather than
comparative-analytic purposes for a number of similar facilities.
b. Age of patients and disability. In the United States,
the proportion of the population aged 65 years of age or older is
expected to increase from approximately 43.1 million in 2012 to an
estimated 71.0 million in 2030; and, the number of persons 80
years or older is projected to increase from 9.3 million in 2000
to 19.5 million in 2030.(31) Meanwhile, hospital inpatient
utilization has experienced an epidemiological evolution in the
leading causes of death from infectious disease and acute
illnesses to chronic disease and degenerative illnesses. This
transition, in conjunction with an increasing age distribution,
has a significant impact in terms of hospitals and other related
facilities experiencing more patient accidents.
Hospitalized patients are generally more often disabled
today than they were 60 years ago whether it is related to a
stroke (32), diabetes (33) or the trend from acute to chronic
coronary heart disease (CHD) (34). Overall hospitalization rates
for CHD has decreased at a young age, but increased at very old
age, another example of why hospitals have more patients today
than 60 years ago, who are more prone to have a fall.
c. Case mix of inpatients. Based on DRGs, there is some
evidence that hospital case mix in U.S. hospitals is becoming more
acutely ill, (35) but this may be more related to institutions
playing with “DRG creep” when they attempt to gain additional
revenues. What is more obvious is that hospitals have shortened
their average length of stay (ALOS) from 7.5 days in l980 (after
the Mount Sinai Hospital study was undertaken) to an ALOS of 4.5
days in 2012. The nation’s hospital admission rate has declined
from 177.4/1,000 persons in 1980 to 113.0/1,000 persons in 2012.
The “easier cases” that generated many admissions 60 years
ago, are now frequently admitted to an ambulatory surgical center
or treated in an outpatient area. The average hospital inpatient
today is more critically ill than a half century ago; and, the
hospital has the fiscal incentives related to DRGs to discharge
them as soon as clinically possible. All of these factors
culminate in many more acutely ill patients in-house, who are more
prone to have a fall. This may be the major driving force why our
patient fall indices are still increasing. Simply, there are a
higher percentage of accident prone patients in our hospitals and
other healthcare facilities today than there were 60 years ago.
d. Less hospital personnel at bedside. Superior nursing
personnel with enhanced academic credentials are thought to be
critical to reduce drug errors and patient falls. Among all
hospital employees, the nursing staff is the group most
responsible for direct patient care. Unfortunately, they are
being saddled with an increasing number of peripheral
responsibilities that take them further away from bedside duties.
That nurses might be spending as much as 75% of their shift away
from patients is of obvious concern. What seems to be increasingly
worrisome is that nurses feel so pressured to secure positive
patient satisfaction scores to the point that their interactions
with patients too often can seem artificial, may be even scripted.
This could be another reason why there has been an increase in
patient falls during the last half century in hospitals and other
related healthcare facilities.
Hitcho et al. (36) reported that patient fall rates were
generally higher among those services with higher patient to nurse
staffing ratios. This finding is consistent with a few of the
early studies focusing on the association between increases in
nurse staffing levels and enhanced clinical outcomes including a
possible reduction in patient falls. (37-40) Since nursing service
is the department in a hospital with the greatest number of
employees, adding more highly trained RNs has a potentially
significant impact of the institution’s fiscal wellbeing.
More recent studies have been focusing, for example, more
directly on how the level of staffing effects adverse patient care
events, including patient falls. Cox et al. (41) reported that the
“implementation of fall prevention strategies and higher RN to
unlicensed assistive personnel staffing ratios, decreased the
likelihood of a fall during hospitalization.” Using unit-level
self-reported data from 215 hospitals. Aydin (42) found that less
accidents occurred by optimizing staffing skill mix. A study (43)
from The Netherlands confirmed the above suggesting that more
advanced levels of nursing education was associated with fewer
Many additional studies are still needed to determine
whether lower patient to nurse staffing ratios are associated with
lower incidence of patient falls, where patient acuity is clearly
delineated in the analysis. This proposed undertaking suggests a
possible research methodology of when a patient accident occurs,
that the nursing staffing pattern in quantitative and qualitative
terms, and the mean average DRG on the patient unit would be
recorded. Although requiring a sophisticated patient accident
reporting system this approach would tie nursing staffing, average
seriousness of illness and disability on unit, and the patient
fall. Conventional wisdom would say that with more qualified
nursing personnel available, there would be lesser patient falls;
and, one would hope that further research would confirm this view
held by some of the nation’s nursing leadership. (44)
Possibly there is another way to reduce patient falls. When
nurses change shifts, they usually record their reports at their
nursing station. With a “return to care” design, nurses make
their change of shift reports at the patient’s bedside with the
patient participating in the conversation. With the patient
involved, the information passed along should be more to the point
and the patient perceives being more involved in the healing
process. It would be worthwhile studying whether with a “return to
care” approach there are less falls or at least less severe ones,
particularly in psychiatric and neuro-skeletal units where
patients already tend to have a higher incidence of incidents and
have longer average lengths of stay.
e. Impact of sedation. Conventional wisdom suggests that
drug use, whether alcohol, illicit substance abuse, or prescribed
drugs significantly increases the risk of falls. There have been a
number of studies (7, 23, 45, 46) that report that medications
such as benzodiazepines, diuretics, laxatives, sedatives, and
anti-depressants increase the likelihood of a patient falling.
This finding seems to be particularly pertinent for patients who
are 80 years or older.
Tideilsaar (13) reported that “some studies have failed to
demonstrate a relationship between falls and drugs.” Although he
has admitted that most patients who do fall have either taken
within a few hours of a fall large doses of laxatives,
tranquilizers and hypnotics, diuretics, psychotropics, or
cardiovascular drugs. The overall evidence suggests that patients
might be significantly safer in terms of patient falls, if they
were less heavily medicated, something not easily implemented
among today’s critically ill or severely disoriented patients.
f. Physical aspects improved. A major contribution of the
Mount Sinai Hospital’s accident study(1) was the discussion at
safety committee meetings in the mid-1950s in the use of full bed
rails to restrain patient falls versus half rails and to lower the
height of the bed to the lowest position after completing
treatments or tasks. The decision then was to implement half
rails. Tzeng and Yin (47) strongly recommended that “low beds
should be used for patients at high risk of falling.” If this
would be uniformly implemented, the number of patient falls would
be reduced and if there was an accident, a shorter distance would
be involved.
g. Effectiveness of safety committees. The current agendas
of most safety committees include medical errors, patient
accidents, and physical plant issues. These three topics might be
too broad a scope in a large institution for one committee meeting
once a month for 90 minutes. The option might be to form sub-
committees for each of the more narrowly defined areas of study,
and have the sub-committees summarize their findings and offer
their recommendations to the full safety committee.
Based on the discipline of the senior authors of the most
frequently published articles related to patient falls, nurses
rather than physicians or representative of the institution’s
executive staff might chair the hospital’s safety committee. More
discussion at such meetings thereby would tend to be patient-
centered, and what nursing and other departments can do to reduce
patient accidents. Although the activities of environmental
services, maintenance, dietary, physical and occupational therapy,
and other departments can affect patient accidents, the central
core of patient accidents is related to nursing service
If the hospital is determined to reduce its number of
patient accidents, it needs to continually keep “on the heat,”
particularly focused on the high-risk clinical areas and those
patients that have had one fall. If a patient accident is reported
on line, is there an automatic warning posted that the patient is
more likely to have another accident within five days?
Hospitals frequently report to the public the results of
their patient satisfaction surveys. May be what needs to occur is
for the hospital to post for its employees (or at least for the
nursing department), the number and the incident rates of patient
falls by patient unit. The usefulness of this recommendation is
that it clearly brings to the attention of those receiving the
message the importance of reducing patient incidents.
Concluding Comments
Almost sixty years ago when sitting in safety committee
meetings at New York City’s Mount Sinai Hospital,(48) with the
then forthcoming advances in the medical sciences and the changes
in hospital reimbursement incentives, one would not have predicted
that our health facilities would experience nationally and
internationally more patient accidents. With an aging population
and more ambulatory versus inpatient services, patient accidents
will become an increasing problem for governing boards, medical
staffs, nurses and other employees, defense attorneys, and
insurance underwriters, who are already concerned about falls
because of patient safety issues, the occasional poor publicity in
the press, and the number of claims filed against healthcare
If we are going to succeed in reducing falls in healthcare
facilities, additional studies will be needed on these and other
questions: is there an effective alternative to our current usage
of benzodiazepines?; although potentially effecting the fiscal
well-being of the facility, how much and what type of professional
nurse staffing is required to significantly reduce the number of
accidents among patients with greater comorbidity?; what patient
fall reporting system will be most effective to focus on avoiding
patients having a second (repeat) accident - - recording the
staffing pattern and average DRG on nursing unit?; if you focused
more on patients optimizing function and activity, would that be
of some assistance in decreasing the number of patient falls?;
what role does patient safety orientation on admission have on
accident prevention?; and, what are the critical factors in making
safety committee activities effective in terms of achieving a
long-term decrease in falls? In the next several decades, with
health facilities experiencing continual cutbacks in revenues and
concurrently admitting a higher percentage of more acutely ill,
aged patients, it is so likely that the topic of preventing
patient falls and related studies will gain increasing public and
professional attention.
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... Ước tính từ Cục điều tra dân số Hoa Kỳ dự đoán rằng dân số lão khoa sẽ tăng gần gấp đôi trong 30 năm tới và sẽ chiếm nhiều hơn 20% dân số nói chung. Theo WHO ngã là nguyên nhân hàng đầu dẫn đến tử vong do thương tích ở người lớn tuổi cũng là một nguyên nhân phổ biến nhất gây thương tích và nhập viện vì chấn thương ở người cao tuổi [12]. Các nghiên cứu đã chỉ ra rằng khoảng một phần ba số người từ 65 tuổi trở lên sẽ bị ngã mỗi năm [11]. ...
... Trên thế giới đã có các nghiên cứu đánh giá mối liên quan giữa tình trạng ngã và sử dụng nhiều thuốc [1], [2], [4], [5], [7], [12], [14]. Nghiên cứu của Freeland KN và cộng sự cho thấy nguy cơ ngã tăng 14% ở những người trên 65 tuổi có dùng từ năm loại thuốc trở lên và nguy cơ ngã tỷ lệ thuận với số loại thuốc được dùng [4]. ...
Mục tiêu: Đánh giá mối liên quan giữa sử dụng nhiều thuốc và ngã ở người bệnh từ 65 tuổi trở lên. Đối tượng và phương pháp: Mô tả cắt ngang trên 605 người bệnh ≥ 65 tuổi khám và điều trị tại Bệnh viện Trung ương Quân đội 108. Sử dụng nhiều thuốc được định nghĩa là dùng đồng thời từ bốn thuốc trở lên. Các thông tin về tiền sử ngã trong một năm trước, các thuốc đang sử dụng được thu thập dựa trên phiếu câu hỏi. Kết quả: Tỷ lệ ngã, ngã nhiều lần, ngã có chấn thương trong 1 năm trước lần lượt là 35,7%, 10,6%, và 8,8% cao hơn ở nhóm sử dụng nhiều thuốc có ý nghĩa thống kê so với nhóm không sử dụng nhiều thuốc. Tỉ lệ ngã tăng theo số thuốc sử dụng. Các nhóm thuốc làm gia tăng nguy cơ ngã ở đối tượng nghiên cứu là: thuốc nhóm benzodiazepin (OR = 4,98); thuốc điều trị tăng huyết áp (OR = 1,86); thuốc lợi tiểu (OR = 1,83); các thuốc ngủ và thuốc an thần (OR = 1,75) và các thuốc điều trị đái đường (OR = 1,69). Kết luận: Sử dụng nhiều thuốc có liên quan đến tăng tỷ lệ có ngã. Sử dụng đồng thời càng nhiều loại thuốc thì càng làm gia tăng tỉ lệ ngã người cao tuổi, các thuốc tăng nguy cơ ngã là nhóm thuốc benzodiazepin, thuốc điều trị tăng huyết áp, thuốc lợi tiểu, thuốc ngủ và thuốc an thần, thuốc điều trị đái tháo đườngMục tiêu: Đánh giá mối liên quan giữa sử dụng nhiều thuốc và ngã ở người bệnh từ 65 tuổi trở lên. Đối tượng và phương pháp: Mô tả cắt ngang trên 605 người bệnh ≥ 65 tuổi khám và điều trị tại Bệnh viện Trung ương Quân đội 108. Sử dụng nhiều thuốc được định nghĩa là dùng đồng thời từ bốn thuốc trở lên. Các thông tin về tiền sử ngã trong một năm trước, các thuốc đang sử dụng được thu thập dựa trên phiếu câu hỏi. Kết quả: Tỷ lệ ngã, ngã nhiều lần, ngã có chấn thương trong 1 năm trước lần lượt là 35,7%, 10,6%, và 8,8% cao hơn ở nhóm sử dụng nhiều thuốc có ý nghĩa thống kê so với nhóm không sử dụng nhiều thuốc. Tỉ lệ ngã tăng theo số thuốc sử dụng. Các nhóm thuốc làm gia tăng nguy cơ ngã ở đối tượng nghiên cứu là: thuốc nhóm benzodiazepin (OR = 4,98); thuốc điều trị tăng huyết áp (OR = 1,86); thuốc lợi tiểu (OR = 1,83); các thuốc ngủ và thuốc an thần (OR = 1,75) và các thuốc điều trị đái đường (OR = 1,69). Kết luận: Sử dụng nhiều thuốc có liên quan đến tăng tỷ lệ có ngã. Sử dụng đồng thời càng nhiều loại thuốc thì càng làm gia tăng tỉ lệ ngã người cao tuổi, các thuốc tăng nguy cơ ngã là nhóm thuốc benzodiazepin, thuốc điều trị tăng huyết áp, thuốc lợi tiểu, thuốc ngủ và thuốc an thần, thuốc điều trị đái tháo đường
... Falls are the most frequently reported incidence among hospital inpatients with 30 to 51 % resulting in some form of injury, rang-ing from minor bruises to severe wounds and fractures [1]. Falls among hospital inpatients contribute to prolonged hospitalization, increasing healthcare costs and litigation risk for the healthcare centre [2]. Inpatient falls also indirectly demonstrates the failure of the healthcare system and quality of medical care. ...
... Despite efforts made to assess the risk of fall among inpatients and early intervention was in place to prevent fall, extrinsic factors such as uneven or slippery floor, inadequate lighting or glare, or insecure handrail may also contribute to fall. Additionally, mobile psychiatric inpatients are also at high risk of falls in view of cognitive impairment, use of psychotropic medications, and behaviour manifestation (such as agitation, wandering) [1,2,4,9]. Therefore, findings from root-cause-analysis related to fall events could be used to improve and reduce the risk of future fall. Furthermore, a good communication between the healthcare providers and patient needs to be established to prevent recurrence of fall. ...
Effective fall risk assessment tool is important for preventive measures to be instituted among psychiatric inpatients. Our study aimed to compare the sensitivity and specificity of Wilson-Sims Fall Risk Assessment Tool (WSFRAT), clinical judgment and Morse Fall Scale (MFS) in the assessment of the risk of fall among psychiatric inpatients. All psychiatric inpatients who were admitted to psychiatric ward of Hospital Tuanku Fauziah, Malaysia from April 1st, 2019, till December 31st, 2020 were assessed for their risk of fall using WSFRAT, clinical judgment and MFS. The frequency and characteristics of actual fall event during period of hospitalization was documented. The study included a total of 400 psychiatric inpatients. Clinical judgment stratified 17 patients as high risk of fall (Mean age: 50.9 ± 12.13 years old, male predominance at 76.5 % and otherwise physically healthy), among which, five actually fell. Among these, four were considered as high risk by WSFRAT and two by MFS. The WSFRAT demonstrated higher sensitivity of fall detection as compared to MFS (60 % vs. 40 %), while the sensitivity of clinical judgment alone without specific fall risks tools was 80 % and a specificity of 96.7 %. Clinical judgement is derived from a comprehensive psychiatric assessment. The value of any objective assessment tool proved to be superior when an element of clinical judgement is concurrently added.
... 11 Düşmeler hastaların hastanede kalış süresinin uzamasına, morbiditeye, mortaliteye, maliyetlerin artmasına neden olmakla birlikte kaygı, sıkıntı, depresyon, azalmış fiziksel aktivite korkusunu da tetikleyebileceği için hastanelerin öncelikli konuları arasında yer almaktadır. [12][13][14][15][16] İngiltere'de hasta güvenliği ile ilgili bildirim yapılan bütün yetişkin hasta ölümlerinin %10'unun hasta düşmeleriyle ilişkili olduğu saptanmıştır. 17 65 yaş ve üzeri bireyler için Finlandiya'da düşmeye bağlı yaralanma başına ortalama maliyetin 3611 dolar, Avustralya'da 1049 dolar olduğu saptanmıştır. ...
... Dışsal faktörler ise daha çok tıbbi cihaz tüp bağlantıları, dağınık elektrik kabloları, uygun olmayan ayakkabılar ve hastanın çevresindeki dağınıklık gibi çevresel engelleri ifade etmektedir. 7,14,20,21 Tıbbi hatalardan öğrenmenin bir yolu, verilerin uygun şekilde yapılandırılan bir formatta toplanıp, altta yatan faktörlerin keşfi ve çözümlerin üretilmesi için etkili bir tıbbi olay bildirim sistemi kullanılmasıdır. 22 Olay bildirim sistemleri hasta güvenliği ile ilgili riskleri tespit etmek, ciddi ve zararlı olayları araştırmak, yaşanan olaylardan ders çıkarmak, kaliteyi ve hasta güvenliğini geliştirmek için bir altyapı sağlar ve güvenlik kültürünü geliştirir. ...
... Over the past years, there has been a marked increase in the number of falls among elderly people, especially those who are hospitalized. The literature justifies this growth with several reasons that, not surprisingly, are interconnected, such as the improvement in accident reporting systems; the increase in mean age or health deterioration of hospitalized people; the reduced time nurses spend with inpatients; the increase in use of sedation therapy (1) ; low levels of knowledge of elderly people regarding adequate strategies to prevent falls (2) ; the fact that individual and team practices not always guarantee safety when it comes to communication, recording, and monitoring of elderly people (3) ; and the hospital setting itself, which differs from the home environment, a fact that can contribute to 30% to 50% of the total number of falls in inpatients (4) . ...
... Fractures that follow falls are one of the most disabling possible consequences, because they trigger a downward spiral in elderly people's health condition, leading to greater dependence or disability and having the potential to result in several complications in the long run (1) . The probability of death caused by a fracture in the upper end of the femur is 2.25 higher when the problem happens in the hospital in comparison with the number recorded for episodes in the community (11) . ...
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Objective: To evaluate the effectiveness of an intervention program in practices and behaviors of a health team to prevent falls in hos pitalized elderly people. Method: This was an action, mixed-methods, and longitudinal study that applied an intervention based on TeamSTEPPS®, and organized into five domains: team training, communication, leadership, monitoring, and mutual support. The population was nurses and nursing aides who worked at the medical service of a Portuguese hospital center. Data were obtained by consulting process records and interviews, and by applying the Scale of Practices and Behaviors of Teams for Fall Prevention. Results: There was improvement in all indicators of the scale, with evident progress in discussion of risk factors and preventive measures to be implemented. Conclusion: This intervention promoted decision-making regarding the preventive measures to be applied to each elderly person and improved communication and the interest in identifying the causes of falls to prevent their recurrence.
... where the material and technological resources invested seem insufficient. Despite efforts made, there has been an increase in the number of patients falls in the last few decades (Weil, 2015). Falls are a persistent problem. ...
... It is estimated that between 23% and 40% of deaths related to injuries in older people are a result of falling (WHO, 2015). Falls among older people occur mostly adjacent to the bed, in the bathroom, during transfers and when walking (Cameron et al., 2018;Weil, 2015). Patient fall history, walking aid use, disability, cognitive impairment and use of medication are factors that increase the risk of falling (Deandrea et al., 2013). ...
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Aim To better understand formal care providers’ role in fall prevention. Design Qualitative synthesis as part of an integrative review. Data sources Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities. 17 studies were included. Review Methods Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo. Findings Primary studies were synthesized with the emerging core category of “Managing and keeping control” and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers’ role in fall prevention in health care facilities. Conclusion Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated. Impact • Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented. • Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy. • This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy.
... In addition, life-threatening falls often occur within the rehabilitation process after major surgery to the hip or leg area, which is an increasing concern for patients and medical experts alike. The risk of repeat falls is especially high in patients who have already sustained a hip fracture [4]. Thus, there is an urgent need for a smart device that can detect falls for orthopedic walker users in real time and alert caregivers for emergency assistance. ...
Full-text available
An accurate, economical, and reliable device for detecting falls in persons ambulating with the assistance of an orthopedic walker is crucially important for the elderly and patients with limited mobility. Existing wearable devices, such as wristbands, are not designed for walker users, and patients may not wear them at all times. This research proposes a novel idea of attaching an internet-of-things (IoT) device with an inertial measurement unit (IMU) sensor directly to an orthopedic walker to perform real-time fall detection and activity logging. A dataset is collected and labeled for walker users in four activities, including idle, motion, step, and fall. Classic machine learning algorithms are evaluated using the dataset by comparing their classification performance. Deep learning with a convolutional neural network (CNN) is also explored. Furthermore, the hardware prototype is designed by integrating a low-power microcontroller for onboard machine learning, an IMU sensor, a rechargeable battery, and Bluetooth wireless connectivity. The research results show the promise of improved safety and well-being of walker users.
... Patients in rehabilitation wards show poor self-care in the prevention of accidents and poor daily activities when they have cognitive impairments, thus requiring continuous supervision over 24 hr (Park et al., 2011). Falls are common in hospitals (Weil, 2015); therefore, it is necessary for nurses working with rehabilitation patients to be aware of their characteristics. ...
Full-text available
Aims: To examine the association of nursing hours given to patients with stroke with clinical characteristics to predict the nursing care needs. Design: Twenty-four-hour observational study METHODS: Nursing hours per patient day (NHPPD) of 171 stroke patients were measured by 146 nursing personnel who worked on the day of the observation. Cognitive function, balance ability and dependency level were assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), the Korean version of the Berg Balance Scale (K-BBS) and the Korean version of the Modified Barthel Index (K-MBI), respectively. Results: The NHPPD were moderately correlated with K-MMSE (r = -.450), K-BBS (r = -.529) and K-MBI (r = -.549). The worse the cognitive function, balance ability and dependency level, the more were the nursing hours given to the patients. Therefore, these factors can be considered to be factors that predict nursing care needs for patients with stroke.
... Risk factors for falls include older age, female sex, a history of falls, specific comorbidities (eg, stroke, orthopedic diseases, anemia, postural hypotension, visual impairment, cognitive impairment, and urinary incontinence), surgery, impaired mobility, muscle weakness, medication (eg, benzodiazepines), and polypharmacy. [4][5][6][7][8][9] Consequently, accurate assessment of the risk factors for falls and accessibility to fall prevention strategies can effectively prevent falls, further reducing unnecessary medical costs and patient injury. ...
Falls are one of the most common accidents among inpatients and may result in extended hospitalization and increased medical costs. Constructing a highly accurate fall prediction model could effectively reduce the rate of patient falls, further reducing unnecessary medical costs and patient injury. This study applied data mining techniques on a hospital's electronic medical records database comprising a nursing information system to construct inpatient-fall-prediction models for use during various stages of inpatient care. The inpatient data were collected from 15 inpatient wards. To develop timely and effective fall prediction models for inpatients, we retrieved the data of multiple-time assessment variables at four points during hospitalization. This study used various supervised machine learning algorithms to build classification models. Four supervised learning and two classifier ensemble techniques were selected for model development. The results indicated that Bagging+RF classifiers yielded optimal prediction performance at all four points during hospitalization. This study suggests that nursing personnel should be aware of patients' risk factors based on comprehensive fall risk assessment and provide patients with individualized fall prevention interventions to reduce inpatient fall rates.
Resumen Objetivo Estimar la incidencia de caídas y conocer sus características en cuanto a localización, temporalidad y lesiones producidas, y analizar las características sociodemográficas y clínicas de los pacientes que sufren caídas. Método Se llevó a cabo un estudio observacional de cohortes retrospectivo, en un hospital de nivel 2 del Servicio Madrileño de Salud. Se estudiaron las caídas de pacientes hospitalizados entre el 1 de julio de 2018 y el 30 de junio de 2019. Se estimó la tasa de incidencia de caídas por 1.000 días de estancia considerando una distribución de Poisson. Se describen las características de las caídas: temporalidad, lesiones producidas, localización de las lesiones y pauta de fármacos. Se registraron características sociodemográficas y clínicas de los pacientes que sufrieron una caída. Se realizó un análisis univariante para comparar los resultados por sexos. Todos los datos se han obtenido de registros de la historia clínica electrónica. Resultados Se estudiaron 132 caídas, que suponen una tasa de 1,61 caídas por 1.000 días de estancia. Hombres, edad avanzada e ingreso a cargo de una especialidad médica presentaron una tasa de caída significativamente mayor. Los pacientes que sufrieron una caída tienen una edad media de 77,5 años (DE 11,7), y tuvieron pautados una mediana de 12,5 fármacos (RIC 9,25-15). El 63,6% de las caídas no presentan lesión alguna. Solo se encontró diferencia en cuanto al género en la situación en la que se produce la caída. Conclusiones Nuestros datos notifican una incidencia de caídas similar a la de centros de nuestro entorno. El perfil del paciente que sufre una caída es el de un hombre mayor, ingresado a cargo de una especialidad médica, con estancias hospitalarias más largas, con alguna comorbilidad y polimedicado, sin una asociación temporal evidente.
Objective To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. Methodology A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. Results One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. Conclusions Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.
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Falls are common among inpatients. Several reviews, including 4 meta-analyses involving 19 studies, show that multicomponent programs to prevent falls among inpatients reduce relative risk for falls by as much as 30%. The purpose of this updated review is to reassess the benefits and harms of fall prevention programs in acute care settings and to identify factors associated with successful implementation of these programs. We searched for new evidence using PubMed from 2005 to September 2012. Two new, large, randomized, controlled trials supported the conclusions of the existing meta-analyses. An optimal bundle of components was not identified. Harms were not systematically examined, but potential harms included increased use of restraints and sedating drugs and decreased efforts to mobilize patients. Eleven studies showed that the following themes were associated with successful implementation: leadership support, engagement of front-line staff in program design, guidance of the prevention program by a multidisciplinary committee, pilot-testing interventions, use of information technology systems to provide data about falls, staff education and training, and changes in nihilistic attitudes about fall prevention. Future research would advance knowledge by identifying optimal bundles of component interventions for particular patients and by determining whether effectiveness relies more on the mix of the components or use of certain implementation strategies. Ann Intern Med. 2013;158:390-396.
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Predictive models for falls, injury falls, and restraint prevalence were explored within nursing unit structures and processes of care. The patient care team is responsible for patient safety, and improving practice models may prevent injuries and improve patient safety. Using unit-level self-reported data from 215 hospitals, falls, injury falls, and restraint prevalence were modeled with significant covariates as predictors. Fewer falls/injury falls were predicted by populations with fewer frail and at-risk patients, more unlicensed care hours, and prevention protocol implementation, but not staffing per se, restraint use, or RN expertise. Lower restraint use was predicted by fewer frail patients, shorter length of stay, more RN hours, more certified RNs, and implementation of fall prevention protocols. In the presence of risk, patient injuries and safety were improved by optimizing staffing skill mix and use of prevention protocols.
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Background: The increase in the prevalence of diabetes over the past few decades has coincided with an increase in certain risk factors for diabetes, such as a changing race/ethnicity distribution, an aging population, and a rising obesity prevalence. Objective: To determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults. Design: Cross-sectional, using data from 5 NHANES (National Health and Nutrition Examination Surveys): NHANES II (1976-1980), NHANES III (1988-1994), and the continuous NHANES 1999-2002, 2003-2006, and 2007-2010. Setting: Nationally representative samples of the U.S. noninstitutionalized civilian population. Patients: 23 932 participants aged 20 to 74 years. Measurements: Diabetes was defined as a self-reported diagnosis or fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or more. Results: Between 1976 to 1980 and 2007 to 2010, diabetes prevalence increased from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for trends for both groups < 0.001). After adjustment for age, race/ethnicity, and body mass index, diabetes prevalence increased in men (6.2% to 9.6%; P for trend < 0.001) but not women (7.6% to 7.5%; P for trend = 0.69). Body mass index was the greatest contributor among the 3 covariates to the change in prevalence estimates after adjustment. Limitation: Some possible risk factors, such as physical activity, waist circumference, and mortality, could not be studied because data on these variables were not collected in all surveys. Conclusion: The increase in the prevalence of diabetes was greater in men than in women in the U.S. population between 1976 to 1980 and 2007 to 2010. After changes in age, race/ethnicity, and body mass index were controlled for, the increase in diabetes prevalence over time was approximately halved in men and diabetes prevalence was no longer increased in women. Primary funding source: Centers for Disease Control and Prevention and National Institutes of Diabetes and Digestive and Kidney Diseases.
Despite efforts in hospitals to identify patients at risk for falls and to prevent these incidents, falls among hospitalized patients are not a rare event and continue to be a major health care concern, occurring in approximately 700,000-1,000,000 hospitalized patients per year. The purpose of this study was to examine intrinsic, extrinsic, and workforce factors that contribute to falls among hospitalized adult patients. A retrospective correlational design was used to examine 160 patients admitted to a medical-surgical unit over the year 2012. Analytical weighting was applied to the study sample to conduct bivariate and multivariate analysis. In multivariate analysis, the variables age, narcotic/sedative use, and overnight shift, significantly predicted the likelihood of a fall during the hospitalization. Cardiovascular disease, neuromusculoskeletal disease, evening shift, the implementation of fall prevention strategies and higher RN to unlicensed assistive personnel staffing ratios decreased the likelihood of a fall during the hospitalization. In addition, patients at high risk for falls using the Hendrich I fall scale were nearly 17% more likely to fall during the hospitalization. Many factors influence the occurrence of a fall in hospitalized patients. Fall risk assessment and the implementation of fall prevention strategies are both effective strategies in the clinical area to identify and decrease the probability of a fall. The presence of the RN is significant in fall prevention in medical-surgical patients. Copyright © 2014 Elsevier Inc. All rights reserved.
Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.Design, Setting, and Participants Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.
To determine if the risk of hip fracture differed between persons receiving benzodiazepines with long (≥24 hours) or short (<24 hours) elimination half-lives, we conducted a nested case-control study among residents of the Canadian province of Saskatchewan who were 65 years of age and older. We identified 4501 cases occurring between 1977 and 1985 from computerized hospital records and 24 041 population controls. Current benzodiazepine use, defined as having filled a prescription in the past 30 days, was ascertained from computerized pharmacy records. The relative risk of hip fracture was 1.7 (95% confidence interval, 1.5 to 2.0) for current users of long half-life benzodiazepines, in contrast to that of 1.1 (95% confidence interval, 0.9 to 1.3) for current users of short half-life drugs. This finding was not altered by sex, age, calendar year, nursing home residence, or history of hospitalization. Medical record review for a sample of 189 cases suggested that this finding was not due to confounding by dementia, ambulatory status, functional status, or body mass. (JAMA. 1989;262:3303-3307)
Background: Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness have important public health consequences. Objective: To assess age-sex-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands. Methods: Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalization rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 205,649 chronic forms of CHD (ICD-9 412, 414) admissions. Results: Between 1998 and 2007, the age-standardized CHD hospitalization rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall, hospitalization rates decreased at younger age (<75 years) but increased in very old age (≥85 years). The annual percentage change in hospitalization rates was larger for AMI (men:-5.1%, women:-4.4%) than for unstable angina patients (men:-2.0%, women:-2.0%). For chronic CHD, the average annual percentage change was +0.7% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women. Conclusions: An increasing proportion of Dutch CHD hospital admissions was for chronic forms of CHD. The age at hospitalization was pushed towards older age: premature CHD admission declined over time and admission rates at very old age increased.
Rationale, aims and objectivesA major problem in hospitals is that of falls, which can seriously reduce patients' quality of life. Fall rates vary considerably depending on health care practices, the hospital environment and the measurement method used. The aim of this study was to determine the characteristics of hospitalized acute patients who suffer falls, by analysing the distribution and the profile of these patients. Methods This is an analytic cross-sectional study conducted at a Spanish hospital. All patients who suffered a fall during hospitalization in 2011 were studied by analysing the computerized register of falls. Downton index, circumstances and consequences of falls were analysed. Descriptive statistics, bivariate analysis and logistic regression analysis were performed. ResultsThe frequency of falls was 0.64%. The rate of falls increased with age (mean age: 71.06 years). The highest percentage occurred among patients in the medical care area (63.7%). The probability of suffering a fall was 1.33 times higher among men than women. Differences in age, type of risk of fall and circumstances were found, depending on the type of hospitalization. Multivariate analysis revealed that patients in the medical care area suffered more falls with consequences: 7.01 [95% confidence interval (CI): 1.34-36.79], as did the patients classified as low risk': 2.40 (CI 95%: 1.02-5.65). Conclusions Falls have diverse causes. Determining these circumstances can contribute to promoting a culture of prevention and to reducing the injuries provoked by falls. Notification procedures should be standardized in order to enable comparisons among different environments.