Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-06-05T17:48:42.963Z Has data issue: false hasContentIssue false
  • English
  • Français

Circumstances of Patient Falls and Injuries In 9 Hospitals In a Midwestern Healthcare System

Published online by Cambridge University Press:  02 January 2015

Melissa J. Krauss ,
Sheila L. Nguyen ,
Wm. Claiborne Dunagan ,
Stanley Birge ,
Eileen Costantinou ,
Shirley Johnson ,
Barbara Caleca  and
Victoria J. Fraser
Melissa J. Krauss*
Affiliation:
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
Sheila L. Nguyen
Affiliation:
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
Wm. Claiborne Dunagan
Affiliation:
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri BJC HealthCare, St. Louis, Missouri
Stanley Birge
Affiliation:
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
Eileen Costantinou
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Shirley Johnson
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Barbara Caleca
Affiliation:
BJC HealthCare, St. Louis, Missouri
Victoria J. Fraser*
Affiliation:
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, 660 South Euclid Avenue, Campus Box 8051, St. Louis, MO 63110 (mkrauss@im.wustl.edu)
Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, 660 South Euclid Avenue, Campus Box 8051, St. Louis, MO 63110 (vfraser@im.wustl.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Preventing hospital falls and injuries requires knowledge of fall and injury circumstances. Our objectives were to determine whether reported fall circumstances differ among hospitals and to identify predictors of fall-related injury.

Design.

Retrospective cohort study. Adverse event data on falls were compared according to hospital characteristics. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for risk factors for fall-related injury.

Setting.

Nine hospitals in a Midwestern healthcare system.

Patients.

Inpatients who fell during 2001-2003.

Results.

The 9 hospitals reported 8,974 falls that occurred in patient care areas, involving 7,082 patients; 7,082 falls were included in our analysis. Assisted falls (which accounted for 13.3% of falls in the academic hospital and 9.8% of falls in the nonacademic hospitals; P <.001) and serious fall-related injuries (which accounted for 3.7% of fall-related injuries in the academic hospital and 2.2% of fall-related injuries in the nonacademic hospitals; P <.001) differed by hospital type. In multivariate analysis for the academic hospital, increased age (aOR, 1.006 [95% CI, 1.000-1.012]), falls in locations other than patient rooms (aOR, 1.53 [95% CI, 1.03-2.27]), and unassisted falls (aOR, 1.70 [95% CI, 1.23-2.36]) were associated with increased injury risk. Altered mental status was associated with a decreased injury risk (aOR, 0.72 [95% CI, 0.58-0.89]). In multivariate analysis for the nonacademic hospitals, increased age (aOR, 1.007 [95% CI, 1.002-1.013]), falls in the bathroom (aOR, 1.46 [95% CI, 1.06-2.01]), and unassisted falls (aOR, 1.83 [95% CI, 1.37-2.43]) were associated with injury. Female sex (aOR, 0.83 [95% CI, 0.71-0.97]) was associated with a decreased risk of injury.

Conclusion.

Some fall characteristics differed by hospital type. Further research is necessary to determine whether differences reflect true differences or merely differences in reporting practices. Fall prevention programs should target falls involving older patients, unassisted falls, and falls that occur in the patient's bathroom and in patient care areas outside of the patient's room to reduce injuries.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 5 , May 2007 , pp. 544 - 550
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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.)

References

1. Sutton, JC, Standen, PJ, Wallace, WA. Patient accidents in-hospital: incidence, documentation and significance. Br J Clin Pract 1994;48:63–6.CrossRefGoogle ScholarPubMed
2. 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.Google Scholar
3. Bates, DW, Pruess, K, Souney, P, Platt, R. Serious falls in hospitalized patients: correlates and resource utilization. Am J Med 1995;99:137–143.CrossRefGoogle ScholarPubMed
4. Aditya, BS, Sharma, JC, Allen, SC, Vassallo, M. Predictors of a nursing home placement from a non-acute geriatric hospital. Clin Rehabil 2003;17:108–113.Google Scholar
5. Scaf-Klomp, W, Sanderman, R, Ormel, J, Kempen, GIJM. Depression in older people after fall-related injuries: a prospective study. Age Ageing 2003;32:88–94.CrossRefGoogle ScholarPubMed
6. Kempen, GIJM, Sanderman, R, Scaf-Klomp, W, Ormel, J. The role of depressive symptoms in recovery from injuries to the extremities in older persons: a prospective study. Int J Geriatr Psychiatry 2003;18:14–22.Google Scholar
7. Tinetti, ME, Williams, CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998;53:M112–M119.CrossRefGoogle ScholarPubMed
8. Kong, KS, Lee, Fk FK, Mackenzie, AE, Lee, DT. Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls. J Adv Nurs 2002;37:234–242.CrossRefGoogle ScholarPubMed
9. Murphy, J, Isaacs, B. The post-fall syndrome: a study of 36 elderly patients. Gerontology 1982;28:265–270.CrossRefGoogle ScholarPubMed
10. 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.CrossRefGoogle ScholarPubMed
11. Tinetti, ME. Clinical practice: preventing falls in elderly persons. N Engl J Med 2003;348:42–49.CrossRefGoogle ScholarPubMed
12. Rubenstein, LZ, Powers, CM, MacLean, CH. Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Ann Intern Med 2001;135:686–693.Google Scholar
13. Tinetti, ME, Doucette, JT, Claus ЕB. The contribution of predisposing and situational risk factors to serious fall injuries. J Am Geriatr Soc 1995;43:1207–1213.Google Scholar
14. 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
15. Tinetti, ME, Liu, WL, Ginter, SF. Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med 1992;116:369–374.Google Scholar
16. 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
17. Rubenstein, LZ, Josephson, KR, Robbins, AS. Falls in the nursing home. Ann Intern Med 1994;121:442–451.Google Scholar
18. Krueger, PD, Brazil, K, Lohfeld, LH. Risk factors for falls and injuries in a long-term care facility in Ontario. Can J Public Health 2001;92:117–120.Google Scholar
19. Fischer, I, Krauss, MJ, Dunagan, WC, et al. Patterns and predictors of inpatient falls and fall injuries in a large academic hospital. Infect Control Hosp Epidemiol 2005;26:822–7.Google Scholar
20. Morris, EV, Isaacs, B. The prevention of falls in a geriatric hospital. Age Ageing 1980;9:181–185.Google Scholar
21. Kellogg International Work Group, Gibson, MJ, Andres, RO, Isaacs, B, Radebaugh, T, Worm-Petersen, J. The prevention of falls in later life: a report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987;34:1–24.Google Scholar
22. Florida Hospital Association Patient Safety Steering Committee. Building the foundations for patient safety. November 2001. Available at: http://www.fha.org/acrobat/patientsafety2.pdf. Access August 31, 2005.Google Scholar
23. Mayo, NE, Korner-Bitensky, N, Levy, AR. Risk factors for fractures due to falls. Arch Phys Med Rehabil 1993;74:917–921.Google Scholar
24. Nevitt, MC, Cummings, SR, Hudes, ES. Risk factors for injurious falls: a prospective study. J Gerontol 1991;46:M164–M170.Google Scholar
25. Vassallo, M, Vignaraja, R, Sharma, JC, Briggs, R, Allen, S. The relationship of falls to injury among hospital in-patients. Int J Clin Pract 2005;59:17–20.Google Scholar