Orthopaedic Injuries following Falls by Hospital In-Patients

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Falls in the acute hospital setting — impact on resource utilisation

“…A study in the United Kingdom estimated costs of treating orthopaedic fall-related injuries that occurred in hospital over a 3-year period to be about £127000 (covering surgery and bed-costs only), with most patients with these injuries requiring between 1 and 5 weeks' additional stay in hospital. 31 Results similar to those of our study were obtained in another study in the US. 21 This previous study showed that hospital LOS was 12 days longer, and hospitalisation costs US$4233 higher for fallers than their non-falling counterparts when matched on age and gender and admission time frame.…”

“…An important difference in our study methodology was analysis within DRGs, which ensures similar groupings of admission causes. It should be noted that the results from our own study, and those of Bates and colleagues 21 and Nadkarni and colleagues 31 only incorporate costs associated with falls while an inpatient. Clearly, for some of these fallers the increased costs persist after discharge in terms of potential need for additional therapy and community support services, as well as indirect costs such as anxiety experienced by patients or caregivers, and these costs were not considered in these studies.…”

Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

“…[2][3][4][5][6] Falls in hospital often result in injuries, increased lengths of stay, and greater costs to the health service. [6][7][8][9] Evidence on the best way to prevent falls in hospital is, however, limited. No single intervention, such as bed alarms or bracelets to identify patients at high risk of falls, has been proved effective in randomised trials.…”

Quedas em internamento hospitalar – causas, consequências e custos: estudo de caso numa unidade hospitalar de Lisboa

“…As quedas de doentes internados não podem ser totalmente evitadas, ocorrendo apesar das medidas preventivas [17]. …”