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Patterns and Predictors of Inpatient Falls and Fall-Related Injuries in a Large Academic Hospital

Published online by Cambridge University Press:  21 June 2016

Irene D. Fischer ,
Melissa J. Krauss ,
William Claiborne Dunagan ,
Stanley Birge ,
Eileen Hitcho ,
Shirley Johnson ,
Eileen Costantinou  and
Victoria J. Fraser
Irene D. Fischer
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Melissa J. Krauss
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
William Claiborne Dunagan
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri BJC Health Care, St. Louis, Missouri
Stanley Birge
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Eileen Hitcho
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Shirley Johnson
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Eileen Costantinou
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Victoria J. Fraser*
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Department of Internal Medicine, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110[email protected]
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Abstract

Objectives:

Most research on hospital falls has focused on predictors of falling, whereas less is known about predictors of serious fall-related injury. Our objectives were to characterize inpatients who fall and to determine predictors of serious fall-related injury.

Methods:

We performed a retrospective observational study of 1,082 patients who fell (1,235 falls) during January 2001 to June 2002 at an urban academic hospital. Multivariate analysis of potential risk factors for serious fall-related injury (vs no or minor injury) included in the hospital's adverse event reporting database was conducted with logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CI95).

Results:

The median age of patients who fell was 62 years (interquartile range, 49-77 years), 50% were women, and 20% were confused. The hospital fall rate was 3.1 falls per 1,000 patient-days, which varied by service from 0.86 (women and infants) to 6.36 (oncology). Some (6.1%) of the falls resulted in serious injury, ranging by service from 3.1% (women and infants) to 10.9% (psychiatry). The most common serious fall-related injuries were bleeding or laceration (53.6%), fracture or dislocation (15.9%), and hematoma or contusion (13%). Patients 75 years or older (aOR, 3.2; CI95, 1.3-8.1) and those on the geriatric psychiatry floor (aOR, 2.8; CI95,1.3-6.0) were more likely to sustain serious fall-related injuries.

Conclusions:

There is considerable variation in fall rates and fall-related injury percentages by service. More detailed studies should be conducted by floor or service to identify predictors of serious fall-related injury so that targeted interventions can be developed to reduce them.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 10 , October 2005 , pp. 822 - 827
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Gaebler, S. Predicting which patient will fall again … and again. J Adv Nurs 1993;18:1895–1902.CrossRefGoogle Scholar
2.Poster, EC, Pelletier, LR, Kay, K. A retrospective cohort study of falls in a psychiatric inpatient setting. Hospital and Community Psychiatry 1991;42:714–720.Google Scholar
3.Morgan, VR, Mathison, JH, Rice, JC, Clemmer, DI. Hospital falls: a persistent problem. J Public Health 1985;75:775–777.Google Scholar
4.Vassallo, M, Sharma, JC. Incidence and prognostic implications of falls associated with acute medical illness: a medical inpatient study. Int J Clin Pract 1998;52:233–235.Google Scholar
5.Parker, R. Assessing the risk of falls among older inpatients. Prof Nurse 2000;15:511–514.Google Scholar
6.Tinetti, ME, Williams, CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997;337:1279–1284.Google Scholar
7.Tinetti, ME. Factors associated with serious injury during falls by ambulatory nursing home residents. J Am Geriatr Soc 1987;35:644–648.Google Scholar
8.Nevitt, MC, Cummings, SR, Hudes, ES. Risk factors for injurious falls: a prospective study. J Gerontol 1991;46:M164–M170.Google Scholar
9.Haines, TP, Benneil, KL, Osborne, RH, Hill, KD. Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ 2004;328:676.CrossRefGoogle ScholarPubMed
10.Vassallo, M, Vignaraja, R, Sharma, JC, et al.The effect of changing practice on fall prevention in a rehabilitative hospital: the hospital injury prevention study. J Am Geriatr Soc 2004;52:335–339.Google Scholar
11.Healey, F, Monro, A, Cockram, A, Adams, V, Heseltine, D. Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Age Ageing 2004;33:390–395.Google Scholar
12.Butler, M, Norton, R, Lee-Joe, T, Coggan, C. Preventing falls and fall-related injuries among older people living in institutions: current practice and future opportunities. N Z Med J 1998;111:359–361.Google Scholar
13.Myers, AH, Baker, SP, Van Natta, ML, Abbey, H, Robinson, EG. Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol 1991;133:1179–1190.Google Scholar
14.Bates, DW, Pruess, K, Souney, P, Platt, R. Serious falls in hospitalized patients: correlates and resource utilization. Am J Med 1995;99:137–143.Google Scholar
15.Hitcho, EB, Krauss, MJ, Birge, S, et al.Characteristics and circumstances of falls in a hospital setting. J Gen Intern Med 2004;19:732–739.CrossRefGoogle ScholarPubMed
16.Krauss, MJ, Evanoff, B, Hitcho, E, et al.A case-control study of patient, medication, and care-related risk factors for inpatient falls. J Gen Intern Med 2005;20:116–122.Google Scholar
17.Mayo, NE, Korner-Bitensky, N, Levy, AR. Risk factors for fractures due to falls. Arch Phys Med Rehabil 1993;74:917–921.Google Scholar
18.Tinetti, ME, Doucette, J, Claus, E, Marottoli, R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995;43:1214–1221.Google Scholar
19.de Carle, AJ, Kohn, R. Risk factors for falling in a psychogeriatric unit. Int J Geriatr Psychiatry 2001;16:762–767.CrossRefGoogle Scholar