Fall rates by specialties and risk factors for falls in acute hospital: A retrospective study

Abstract

Background Falls are common adverse events in acute care hospitals, and about 25–50% of fallers suffer injuries. In acute care, fall rates range from 0.4–9 falls per 1000 patient days, varying among unit types, patient characteristics, and diseases. Several risk factors have been identified, including recent falls, age, reduced mobility, cognitive ability and polypharmacy. Several countries have become an aging society in which an increasing number of older patients need acute care. Therefore, the prevention of falls has become one of the most important aspects of patient safety. Aim and Design This retrospective study aimed to explore adults' inpatient falls in a Finnish university hospital with several specialties. The objectives were to draw an overall picture of fall rates in Finnish acute care, and to model risk factors for falls including secondary diagnoses. Methods The study was conducted in a large university hospital in Finland. The data consisted of patients' electronic health records from 2014–2016 and included a total of 114,951 adult patients. Univariable and multivariable binary logistic regression model analysis was used to identify risk factors for falls and multiple imputation was used to missing data. The study reporting followed the STROBE guidelines. Results A total of 841 falls were recorded, totalling 1.5 falls per 1000 patient days, and the rate of falls with injury was 0.4 per 1000 patient days. The regression model included the following risk factors: increasing old age, prolonged hospital stays, specialty of neurology, mode of arrival (emergency care and hospital transfer), no operation during hospital stays and secondary diagnoses such as dementia, pneumonia and alcohol abuse. Conclusions In acute care, falls occur most in patients with neurological diagnoses and least in surgical patients. Risk factors for falls include increasing age, emergency arrival, hospital transfer and prolonged hospital stay. Relevance to Clinical Practice Educational interventions to improve healthcare professionals' competence and preventive interventions to avoid inpatient falls need to be prioritized in medical specialties with high fall rates.

Congruency and its related factors between patients' fall risk perception and nurses' fall risk assessment in acute care hospitals

“…In the present study, hospitalization period and department (orthopedics) were independent factors influencing the underestimation of fall risk in inpatients. This study's finding that length of stay is related to underestimation of fall risk is consistent in that the longer length of stay was reported as an associating factor for falling accidents among inpatients (Heikkilä et al., 2023; Najafpour et al., 2019). This result may be due to the possibility that, as the length of stay increased, patients adapted to the hospital environment and perceived their risk of falling as low compared with the actual risk.…”

Comparing risk-adjusted inpatient fall rates internationally: validation of a risk-adjustment model using multicentre cross-sectional data from hospitals in Switzerland and Austria

“…As the convergence issue was related to the continuous variable “age” in the model, we decided to transform the variable into a categorical variable in order to reduce model complexity. Following Heikkilä et al [ 40 ] and Thomann et al [ 41 ] the subsequent four age categories were created: 18–64 years, 65–74 years, 75–84 years and older than 84 years. By introducing “age” as a categorical variable in the inpatient fall risk adjustment model, the convergence problems could be solved.…”

Healthcare Professionals’ Insights Regarding the Applicability of the STEADI Falls Prevention Program Among Neurology Patients: A Qualitative Study

“…While many hospitalized patients face the risk of falling, those with neurological health problems are more susceptible due to the diverse range of conditions they experience, including traumas, tumors, strokes, neuralgia, and functional disorders. 4–6 Confusion, vertigo, imbalance, and dizziness contribute to neurology patients’ increased risk of falls. 7–9 Neurology patients, including those undergoing neurosurgery, also have additional risk factors such as low awareness, limited movement, orthostatic hypotension, vesical or intestinal disturbances, sensory problems, and muscle weakness.…”