Patterns and Predictors of Inpatient Falls and Fall‐Related Injuries in a Large Academic Hospital •

Washington University in St. Louis, San Luis, Missouri, United States
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 11/2005; 26(10):822-7. DOI: 10.1086/502500
Source: PubMed


Most research on hospital falls has focused on predictors of falling, whereas less is known about predictors of serious fall-related injury. Our objectives were to characterize inpatients who fall and to determine predictors of serious fall-related injury.
We performed a retrospective observational study of 1,082 patients who fell (1,235 falls) during January 2001 to June 2002 at an urban academic hospital. Multivariate analysis of potential risk factors for serious fall-related injury (vs no or minor injury) included in the hospital's adverse event reporting database was conducted with logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CI95)
The median age of patients who fell was 62 years (interquartile range, 49-77 years), 50% were women, and 20% were confused. The hospital fall rate was 3.1 falls per 1,000 patient-days, which varied by service from 0.86 (women and infants) to 6.36 (oncology). Some (6.1%) of the falls resulted in serious injury, ranging by service from 3.1% (women and infants) to 10.9% (psychiatry). The most common serious fall-related injuries were bleeding or laceration (53.6%), fracture or dislocation (15.9%), and hematoma or contusion (13%). Patients 75 years or older (aOR, 3.2; CI95, 1.3-8.1) and those on the geriatric psychiatry floor (aOR, 2.8; CI95, 1.3-6.0) were more likely to sustain serious fall-related injuries.
There is considerable variation in fall rates and fall-related injury percentages by service. More detailed studies should be conducted by floor or service to identify predictors of serious fall-related injury so that targeted interventions can be developed to reduce them.

21 Reads
  • Source
    • "While falls can occur at any age, those over 65 have greater rates and more severe consequences, including death, which is considered the sixth leading cause of mortality in this group [1] [2] [3]. Additionally, injuries sustained from falls in this age group predispose individuals to declines in motor abilities required for day-to-day life, including loss of function in independent living activities and further disease and co-morbidities [4] [5].Little is known about patient falls in hospitals [6] [7].Further underlining the need for this specialized attention is the fact that falls comprise the largest single category of reported incidents in hospitals [8].Most falls occurred in the patient's room (50-85%) on or near the bed while unassisted (79%), citing lost balance as the most common reason (12%) [5] [9] [10] [11].While it is unlikely that all falls can be avoided, it is both possible and necessary to continue efforts at finding simple methods to reduce falls in the most vulnerable populations across a wide variety of in-patient settings.Since many falls occur proximal to the hospital bed, our study sought to examine the influence of various bed heights during the sit-to-walkmovement in a fall-prone population using quantitative methods. Sit-to-walk (STW) is an everyday motor task and is fundamental for independence. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the fact that falls comprise a large percentage of hospital injuries, little is known quantitatively about what induces patient falls. Our study quantified kinematic and temporal parameters at key events of the sit-to-walk movement during hospital bed egress. Sixty five older adults (67.6 +/-14.1 years) with a history of falls (Morse Fall Scale score 53.3 +/- 21.4) comprised the study population. Full-body biomechanics during unconstrained sit-to-walk movements were captured as participants exited an adjustable, instrumented hospital bed at three bed heights classified as high, medium, and low. Trunk momentum during peak vertical velocity (i.e. rising) was significantly smaller during high bed exits than the other two bed heights. Change in center of mass velocity between seat-off and first toe-off was significantly faster during medium bed exits vs low bed exits. Temporal variables in low bed conditions revealed delays in rising and gait initiation. These temporal delays indicate lack of confidence and prioritization of postural stability. Since sit-to-walk momentum values were not significantly different between bed heights, this suggests individuals are using similar strategies to generate motion but executing the motion differently in each condition. Therefore lower bed heights may be inappropriate for fall-prone individuals due to increased postural demands. If an optimal setting for hospital bed height exists, our data indicate it may lie in the range of knee height or slightly higher.
    Full-text · Article · Dec 2015
  • Source
    • "Falls are usually defined as a sudden unexpected change in position from a standing, sitting, or horizontal position . This includes slipping from a chair to the floor, finding a patient lying or sitting on the floor, and assisted falls (Fischer et al., 2005). Several definitions emphasize that the change in position is unintentional, and is not caused by sudden paralysis, an epileptic seizure, or a strong blow (Feder, Cryer, Donovan, & Carter, 2000). "
    [Show abstract] [Hide abstract]
    ABSTRACT: PurposeTo identify risk factors for elder falls in a geriatric rehabilitation center in Israel.DesignRetrospective chart review study.Methods Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not.FindingsOf elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition.Conclusions The research findings single out patients who are allegedly at a lower risk of falls than more complex patients.Clinical RelevanceCaregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular.
    Full-text · Article · Jul 2014
  • Source
    • "Falls during hospitalization pose a significant health risk to the patient, as up to 33% of these falls may result in injury (Bates, Pruess, Souney, & Platt, 1995; Fischer et al., 2005; Morgan, Mathison, Rice, & Clemmer, 1985). Injuries resulting from falls include serious complications such as fractures , cranial and soft tissue injuries as well as anxiety, depression, and a loss of confidence resulting in a decrease in independence, and impact on patients' perceptions of safety (Fischer et al., 2005; Schwendimann, Buhler, De Geest , & Milisen, 2006). This psychosocial impact of a fall has been reported to have an enduring effect (Adkin, Frank, Carpenter, & Peysar, 2002; Kressig et al., 2001; Legters, 2002; McKee et al., 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Unintentional falls account for 70% of all hospital accidents. The objective of this study was to identify risk factors for falls and develop an assessment tool specific for an inpatient rehabilitation facility setting. Diagnosis and Functional Independence Measure (FIM) scores were collected for 174 patients to assess predictors for fall risk. Independent t-tests, chi-square, and logistic regression analysis were conducted to examine differences between fallers and nonfallers. We identified several risk factors for falls including 4 FIM items: toileting, bed transfer, tub/shower transfer, and stairs; and three diagnoses: right stroke, traumatic brain injury, and amputation. From these findings, we completed initial development of a risk assessment tool. Evaluation of the tool suggests good specificity with 20%-30% of the patient population identified as high risk and good sensitivity by correctly predicting nearly 90% of patient falls. Continued evaluation of this assessment tool is needed to identify effectiveness in predicting patients who are at high risk for falling.
    Preview · Article · Mar 2014 · Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses
Show more