Characteristics and Circumstances of Falls in a Hospital Setting

A Prospective Analysis

Authors

  • Eileen B. Hitcho MS,

  • Melissa J. Krauss MPH,

    Corresponding authorSearch for more papers by this author
  • Stanley Birge MD,

  • William Claiborne Dunagan MD,

  • Irene Fischer MPH,

  • Shirley Johnson RN, MS, MBA,

  • Patricia A. Nast RN,

  • Eileen Costantinou MSN, RN,

  • Victoria J. Fraser MD

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    • Address requests for reprints to Dr. Fraser: Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (e-mail: vfraser@im.wustl.edu).


  • Received from the Department of Medicine, Washington University School of Medicine (EBH, MJK, SB, WCD, IF, PAN, VJF), Barnes-Jewish Hospital (SJ, EC), and BJC HealthCare (WCD), St. Louis, Mo.

Address correspondence to Ms. Krauss: Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (e-mail: mkrauss@im.wustl.edu).

Abstract

OBJECTIVE:  To describe the epidemiology of hospital inpatient falls, including characteristics of patients who fall, circumstances of falls, and fall-related injuries.

DESIGN:  Prospective descriptive study of inpatient falls. Data on patient characteristics, fall circumstances, and injury were collected through interviews with patients and/or nurses and review of adverse event reports and medical records. Fall rates and nurse staffing levels were compared by service.

SETTING:  A 1,300-bed urban academic hospital over 13 weeks.

PATIENTS:  All inpatient falls reported for medicine, cardiology, neurology, orthopedics, surgery, oncology, and women and infants services during the study period were included. Falls in the psychiatry service and falls during physical therapy sessions were excluded.

MEASUREMENTS AND MAIN RESULTS:  A total of 183 patients fell during the study period. The average age of patients who fell was 63.4 years (range 17 to 96). Many falls were unassisted (79%) and occurred in the patient's room (85%), during the evening/overnight (59%), and during ambulation (19%). Half of the falls (50%) were elimination related, which was more common in patients over 65 years old (83% vs 48%; P < .001). Elimination-related falls increased the risk of fall-related injury (adjusted odds ratio, 2.4; 95% confidence interval 1.1 to 5.3). The medicine and neurology services had the highest fall rates (both were 6.12 falls per 1,000 patient-days), and the highest patient to nurse ratios (6.5 and 5.3, respectively).

CONCLUSIONS:  Falls in the hospital affect young as well as older patients, are often unassisted, and involve elimination-related activities. Further studies are necessary to prevent hospital falls and reduce fall injury rates.

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