Hostname: page-component-669899f699-ggqkh Total loading time: 0 Render date: 2025-04-25T05:27:51.469Z Has data issue: false hasContentIssue false
  • English
  • Français

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]
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

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