Orthopaedic Injuries following Falls by Hospital In-Patients

Department of Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK.
Gerontology (Impact Factor: 3.06). 09/2005; 51(5):329-33. DOI: 10.1159/000086370
Source: PubMed


Falls are one of the most frequent episodes on the hospital wards. Objective: To identify orthopaedic injuries sustained by in-patients falling on the hospital wards and to find out what treatment these required along with the additional time and cost that this incurred.
A retrospective analysis of 900 incident forms and case records was undertaken for a 3-year period. Fractures and other soft-tissue injuries sustained and time, place, and mode of injury were noted. Type of fractures sustained and specific treatment required including operative procedure needed were studied. The cost of each treatment and the total cost in terms of time and money were calculated.
We identified 42 patients with orthopaedic injuries; 53% of the falls were recorded on medical wards. A poor pre-fall mobility was an important factor in over 80% of the cases, and a variety of medical conditions pre-existed in the elderly ill patients. Eighteen patients (42%) sustained hip fractures, of whom 15 patients (36%) required surgical treatment. There were 9 deaths in total, 5 of them occurred in patients with hip fractures. The cost of treating the injuries amounted to about GBP 70,000. An additional hospital stay of 56 weeks in total was needed, most patients requiring between 1 and 5 weeks of additional stay.
Falls in elderly in-patients can result in a variety of skeletal injuries. These may require major operative procedures and result in significant morbidity and can prove fatal. The treatment of these injuries is a substantial added expenditure to the trust.

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    • "Falls can have serious consequences; 30–51% of falls in hospitals result in some injury, with fractures occurring in 1–3%[2]. People who are hospital inpatients when they fall and fracture have poor outcomes[4]and, if they survive, greatly extended lengths of stay[5]. Even falls with minor or no injury can cause anxiety and distress to patients, their families and hospital staff, creating a downward spiral where fear of falling leads to reduced mobility and increased dependency. "
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    ABSTRACT: BACKGROUND: inpatient falls are an important safety challenge, with around half causing physical injuries that compromise the recovery of older, frailer patients. Falls risk scores are in widespread use, but validation studies of their predictive values are few. OBJECTIVES: to assess the predictive values of the Morse falls score (MFS) in an acute general hospital. METHODS: age, admitting speciality, MFS, and any falls in the subsequent 7 days were collected in April 2011 through case note review and incident reporting systems. RESULTS: a total of 467 inpatients were included in the study; 51% were aged 75+ years; 56% had an MFS ≥25; 23% had an MFS ≥55; 28 fell. An MFS ≥25 was not significantly better than chance in the total sample or in any subgroups considered (YI: -0.01 to 0.15). An MFS ≥55 was significantly better than chance for the total sample (YI: 0.39), patients ≥75 years (YI: 0.31) and geriatrician-led wards (YI 0.37), although either sensitivity or specificity fell below 70% in each of these groups. Other subgroups did not demonstrate significantly better accuracy than chance, but may have been affected by type II error. CONCLUSIONS: using MFS ≥25 cannot be clinically justified, while using MFS ≥55 would be contingent on an effective intervention that was ethically acceptable to withhold from the patients with an MFS < 55, despite >40% of falls occurring in that group. Given similar limitations of alternative falls risk scores, hospitals should consider directly assessing and acting on individual patients' specific modifiable risk factors for falls.
    Preview · Article · May 2013 · Age and Ageing
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    • "Falls are the most common cause of incident reports in long-term care facilities and hospitals [1-3]. Falls can result in physical and psychological trauma; even mortality and increased costs due to prolonged hospital stays [1,4,5]. "
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    ABSTRACT: Background Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. Methods A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. Results The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, “the balancing act”. The theme includes three categories: “the right to decide”, “the constant watch”, and “the ongoing negotiation” as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients’ appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients’ risk of falling and to be active to prevent falls. At the acute ward, the words “risk of falling” were not used and fall prevention were not discussed; instead the licensed practical nurses used for example “dizzy and pale”. The results also indicated differences in components that facilitate workplace learning and knowledge transfer. Conclusions Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.
    Full-text · Article · Oct 2012 · BMC Geriatrics
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    • "In particular, patient falls are recognized as one of the most common preventable adverse events in an inpatient setting, and was one of the top five sentinel events in 2010 (The Joint Commission, 2011). Patient falls are devastating to patients, family members , providers, and the healthcare system , with 30%Y42% of falls leading to injury (Fischer et al., 2005; Nadkarni, Iyengar, Dussa, Watwe, & Vishwanath, 2005; Schwendimann, Bü hler, De Geest, & Milisen, 2006). In addition, costs associated with fall-related injuries in U.S. hospitals are no longer reimbursable by the Center for Medicare and Medicaid Services (Kurtzman & Buerhaus, 2008). "
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    ABSTRACT: Nursing documentation is the record of care that is planned and given to patients, yet it is often missing or incomplete. A study of translating results from nurses' assessments of fall risk into tailored interventions using health information technology was used to examine nursing documentation of risk assessment, plans to manage those risks, and interventions to prevent falls. The aim of this study was to evaluate the effectiveness of an electronic fall prevention toolkit for promoting documentation of fall risk status and planned and completed fall prevention interventions. Nursing documentation related to fall risk and prevention was reviewed in 30% of randomly selected medical records for patients on the eight study units (four intervention units; 5,267 patients) and four usual care units (5,116 patients) during three separate study visits. Patients on the intervention units were more likely to have fall risk documented (89% vs. 64%, p < .0001). There were significantly more comprehensive plans of care for the patients on the interventions documented, although no differences were found related to documentation of completed interventions compared with usual care unit patient records. The documentation of fall risk status and planned interventions tailored to patient-specific areas of risk was significantly better on the intervention units that used the fall prevention toolkit as compared with usual care units. Improved documentation quality did not extend to the documentation of completed interventions.
    Full-text · Article · May 2012 · Nursing research
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