Characteristics of Hospital Inpatient Falls across Clinical Departments

Abstract

Background: Hospital inpatient falls are common and may lead to injuries and prolonged hospitalization. Although hospital studies have reported overall fall rates and injuries associated with falls, few have addressed population characteristics and circumstances of falls across clinical departments within a hospital setting. Objective: To determine inpatient fall rates in an urban public hospital and to explore associated characteristics across clinical departments. Methods: The study was conducted in a 300-bed urban public hospital in Switzerland from 1999 to 2003. Patient data and data from the hospital’s standardized fall reporting system on hospital inpatients’ first falls, along with associated characteristics, across the departments of internal medicine, geriatrics and surgery, were analyzed. Descriptive statistics and statistical tests: χ² and ANOVA tests with multiple comparisons tests (post-hoc analysis) were used. Results: Over this 5-year period, 34,972 patients were hospitalized (female 53.6%; mean age 67.3 ± 19.3 years; mean length of stay 11.9 ± 13.2 days) including 2,512 patients (7.5%) who experienced at least one fall during their hospitalization (geriatrics 24.8%; internal medicine 8.8%; surgery 1.9%). The fall rates per 1,000 patient (adjusted for age) days differed significantly between all of the departments (geriatrics 10.7; internal medicine 9.6; surgery: 3.2) (p < 0.001). Overall, 30.1% of the patients who fell experienced minor injuries and 5.1% major injuries. In geriatrics, fall-related circumstances such as transferring were more common (40.4%) than in medicine (33%) or surgery (30.4%) (p < 0.001), whereas falling out of bed was rarer (16.4%) (surgery 27.1%; internal medicine 20.5%) (p < 0.001). In addition, the prevalence of risk factors among patients who fell varied significantly among clinical departments, except for impaired cognition and narcotic use. Conclusion: In the hospital studied, inpatient falls are significantly more common in departments of geriatrics and internal medicine than in surgical departments. Fall rates, related injuries and circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics. When monitoring falls, hospitals should therefore consider differences in characteristics associated with patient falls across clinical departments. High priorities should be allocated in view of identifying patients at risk of falling and implementing fall prevention strategies and interventions.

Caracterização das quedas de pacientes em hospital especializado em cardiologia

“…[19][20] Neste contexto, os medicamentos com repercussões fisiológicas merecem atenção da equipe de enfermagem no sentido de prevenir a ocorrência de quedas. Para que o profissional consiga ter esse olhar deve possuir conhecimentos e aplicar a sistematização de enfermagem, ferramenta indispensável para implementação de assistência individualizada e pautada nas demandas de cuidado.…”

Meta‐analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population

“…13,[32][33][34][35][36] Less consistency is seen with other traditional risk factors such as age, sedating medication, and length of stay. 5,13,32,[36][37][38] Attempting to risk-stratify patients using simple and accurate assessment tools developed from these risk factors has proven to be very difficult. Many tools have been developed based on identified risk factors, but perform very poorly when trying to identify patients who will fall with reasonable specificity and positive predictive value.…”

Falls Among Patients Who Had Elective Orthopaedic Surgery: A Decade of Experience From a Musculoskeletal Specialty Hospital

“…Although our rate of 2.0 falls per 1000 inpatient days is on the low end of published estimates, it is still within the reported range of 0 to 10.7 per 1000 patient days in other general acute hospitals and retirement and long-term facility settings. 2,10,13,15,16 Fortunately, the risk of serious injuries resulting from falls in this patient population was very low (3.3%), which is reassuring for patients undergoing elective orthopaedic procedures. However, patients whose fall resulted in a serious outcome were more likely to fall earlier in their stay (mean postoperative days, 2.7 versus 4.1; P = .003).…”