Do falls and falls-injuries in hospital indicate negligent care--and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006

Oliver, David; Killick, Sally; Even, T; Willmott, Micky

doi:10.1136/qshc.2007.024703

Cited by 45 publications

(35 citation statements)

References 12 publications

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“…[2][3][4][5][6][7] Inpatient falls remain a main focus of patient safety and a measure of quality in this era of healthcare reform and quality improvement. 8 Inpatient fall rates per 1000 patientdays range from 1.4 to 18.2.…”

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

DiBardino

Cohen

Didwania

2012

Journal of Hospital Medicine

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BACKGROUND:Inpatient falls are common adverse events that lead to inpatient injury, increased length of stay, healthcare costs, litigation, and are a focus of patient safety and healthcare quality. Fall prevention methods are currently evolving to address the problem.PURPOSE:To examine the available data evaluating multidisciplinary fall prevention strategies in the acute inpatient setting.DATA SOURCES:A complete literature search of MEDLINE, CINAHL, EMBASE and the Cochrane Library through December 2011 was used. The bibliographies of all systematic reviews and meta‐analyses were hand searched.STUDY SELECTION:Only primary research studies relating to acute care inpatient hospital multidisciplinary fall prevention were included. Selected papers were assessed for quality by 2 authors using a 20‐point scale previously used in the fall literature.DATA EXTRACTION:Each selected study was carefully hand searched by 2 authors for the purposes of data extraction. Study results, in fall rate per 1000‐patient days, and the characteristics of the interventions used were extracted for analysis.DATA SYNTHESIS:Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random‐effects meta‐analysis.CONCLUSIONS:Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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

DiBardino

Cohen

Didwania

2012

Journal of Hospital Medicine

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“…4 Although successful litigation cases related to hospital falls are relatively rare (less than 30 per year in England) and the financial settlements are usually low (averaging around £13 000), 5 the considerable potential for harm to patients and to the hospital's reputation make the prevention of falls an important patient safety challenge for clinical and managerial staff.…”

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Older patients and falls in hospital

Healey¹,

Darowski²

2012

Clinical Risk

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Over a quarter of a million falls are reported by the UK hospitals each year, predominantly harming older patients whose vulnerability to falling arises from a complex interaction of risk factors, including impaired mobility, dementia, delirium, medication and the effects of long term and acute illness. Systematic review of research trials indicates that multifactorial assessment and intervention to treat, modify or better manage these underlying risk factors can reduce falls by 20 -30%. However, the evidence base is not always reflected in hospitals' falls prevention policies, and is not consistently delivered to patients. The organizational culture and processes that can increase the effective delivery of evidence-based falls prevention are discussed, alongside learning from quality improvement projects. Systematic learning from reported falls and essential care after an inpatient fall are also explored.The scale of the challenge Falls are defined as "an unexpected event in which the participant comes to rest on the ground, floor, or lower level" 1 -a definition that in the hospital setting encompasses slips, trip, faints, collapses and patients who are found on the floor. 2 Falls are the most commonly reported patient safety incident in almost all acute and community hospitals and mental health units, with over 280 000 falls reported in England and Wales each year 3 and over a thousand falls per year reported from an acute hospital of average size. 2 Falls predominantly affect and harm older, frailer people; over 80% of falls in hospital occur in patients aged over 65 years, with the highest falls rates and the greatest vulnerability to injury seen in patients aged over 85 years. 2 Falls can have serious consequences; 30% of falls in hospitals result in some injury, and almost 2000 fractures are reported annually. 3 People who are hospital patients when they fall and fracture have poor outcomes and greatly extended lengths of stay and for some, the "final straw" of a serious injury on top of their pre-existing long term and acute illnesses will prove fatal. 4 Inquests into the deaths of patients who have fallen in hospital frequently indicate a catalogue of missed opportunities to prevent the fall (Box 1).Not all falls have such serious consequences, but even falls with minor or no injury can cause anxiety and distress to patients and their families, and create a downward spiral where the fear of falling leads to reduced mobility, increased dependency and an extended length of stay, or triggers a move to a care home. 4 Although successful litigation cases related to hospital falls are relatively rare (less than 30 per year in England) and the financial settlements are usually low (averaging around £13 000), 5 the considerable potential for harm to patients and to the hospital's reputation make the prevention of falls an important patient safety challenge for clinical and managerial staff.

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“…The use of bed rails has been identified as a component of a risk averse safety culture. Oliver et al (2008) suggest that falls could be 'cited as a failure in the duty of care (a crucial feature of successful clinical negligence claims [in the UK])'. The increased use of rails (to prevent falls) can lead to a change in clinical practice with restriction in movement and patient autonomy which, in turn, may limit or delay rehabilitation.…”

Section: When Are Rails Used?mentioning

confidence: 99%

Conflicting Benefits and Hazards of Hospital-Style Bed Rails

Hignett¹

2010

Advances in Human Factors and Ergonomics Series

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• This is a conference paper. ABSTRACTThis paper reviews the design and use of hospital-style bed rails. Rails were originally used as a safety feature for psychiatric patients at risk of falling in the 1800s. There are benefits, for example security in transit, facilitating repositioning, but also hazards, including deaths and injuries associated with entrapment. The developments in the technological specification of hospital beds (electric) has increased with their functionality. However, a survey in England and Wales found that patients on electric beds / pressure mattresses were three times more likely to have their rails raised. This may lead to an increase in the exposure to the risks associated with bed rails and presents a conflict for designers, staff and patients.

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Do falls and falls-injuries in hospital indicate negligent care--and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006

Cited by 45 publications

References 12 publications

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

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

Older patients and falls in hospital

Conflicting Benefits and Hazards of Hospital-Style Bed Rails

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