Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study

Abstract

BackgroundUnassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals.MethodsSeventeen hospitals reported 353 falls over 2 years. We categorized falls by type (assisted vs. unassisted) and outcome (injurious vs. non-injurious). We used multivariate logistic regression to determine factors that predicted fall type and outcome.ResultsWith all other factors being equal, the odds of falling unassisted were 2.55 times greater for a patient aged ≥65 than < 65 (95% confidence interval [CI] = 1.30–5.03), 3.70 times greater for a patient with cognitive impairment than without (95% CI = 2.06–6.63), and 6.97 times greater if a gait belt was not identified as an intervention for a patient than if it was identified (95% CI = 3.75–12.94). With all other factors being equal, the odds of an injurious fall were 2.55 times greater for a patient aged ≥65 than < 65 (95% CI = 1.32–4.94), 2.48 times greater if a fall occurred in the bathroom vs. other locations (95% CI = 1.41–4.36), and 3.65 times greater if the fall occurred when hands-on assistance was provided without a gait belt, compared to hands-on assistance with a gait belt (95% CI = 1.34–9.97).ConclusionsMany factors associated with unassisted or injurious falls in rural hospitals were consistent with research conducted in larger facilities. A novel finding is that identifying a gait belt as an intervention decreased the odds of patients falling unassisted. Additionally, using a gait belt during an assisted fall decreased the odds of injury. We expanded upon other research that found an association between assistance during falls and injury by discovering that the manner in which a fall is assisted is an important consideration for risk mitigation.

Evaluation of Automated Video Monitoring to Decrease the Risk of Unattended Bed Exits in Small Rural Hospitals

“…Specifically, younger adults and those at low risk for falls may exit the bed unattended more frequently than older adults and those at high risk for falls (Table 3 ). However, the older a patient, the longer is the lead time provided by an alert so that older patients, who are at highest risk for fall-related injuries, 6 , 56 also have the greatest lead time before an UBE (Fig. 5 ).…”

“…We requested that hospitals report fall event data during the study using a secure online system developed for previous studies. 6 , 14 The AVMS consisted of a room sensor, mobile devices for nursing staff, and a central monitor at the nurse’s station (Fig. 2 ).…”

“… 13 , 14 An assisted fall occurs when staff lower a patient to the ground. Assisted falls are significantly less likely to result in injury than unassisted falls 6 , 13 and are a system success in the context of early mobilization to prevent secondary functional decline. 15 Using gait belts to assist mobility is associated with decreased odds of unassisted falls and decreased odds that assisted falls result in injury.…”

“… 15 Using gait belts to assist mobility is associated with decreased odds of unassisted falls and decreased odds that assisted falls result in injury. 6 …”

Factors Associated With Severity of Falls In Adult Hospital Patients: A Retrospective Audit

“…Injurious falls in hospitalised patients are a serious concern for patient care. The incidence of inpatient falls ranges from 1.7 to 16.9 per 1000 patient-days [1][2][3][4]. The incidence rates for fall-related injuries range from 6.8%-72.1% for mild and 0.7%-30% for severe injuries [5].…”