Abstract
Background: Inpatient falls are common hospital adverse events. We aimed to determine inpatient fall rates in an urban public hospital and analyzed their characteristics across clinical departments. Methods: The study was conducted in a 350-bed urban, multi-specialty public hospital in the 2013–2019 period. Patient data were retrieved from the hospital’s standardized falls reporting system. Descriptive statistics and statistical tests: chi2 and ANOVA tests with multiple comparison tests (post-hoc analysis) were used. For fall incidence estimation a joint-point regression was applied. p-value of 0.05 was considered as statistically significant for all the calculations. Results: The highest prevalence of falls was reported in the rehabilitation and internal medicine wards (1.915% and 1.181%, respectively), the lowest in the orthopedic (0.145%) and rheumatology wards (0.213%) (p < 0.001). The vast majority of falls took place in the late evening and during the night (56.711%) and were classified as bed falls (55.858%). The crude incidence rate (cIR) of falls was 6.484 per one thousand hospitalizations. In the 2013–2017 period, an increase in total cIR was observed, reaching the peak value in 2016; it was followed by a slight decline from 2017 to 2019, however, differences in changes were observed between the wards. Conclusion: Fall rates and trends as well as circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics.
Highlights
The most widely used definition of a fall occurring within a healthcare setting is the one proposed by Nitz and Johnston, which describes it as “an unexpected event in which the participant comes to rest on the ground, floor, or lower level” [1]
In this study we aimed to investigate the occurrence of inpatient falls in all wards of a public city hospital in the past seven years, and to analyze the circumstances of these events; we investigated changes in the incidence of falls
There were no significant differences in BMI of fallers across the analyzed departments
Summary
The most widely used definition of a fall occurring within a healthcare setting is the one proposed by Nitz and Johnston, which describes it as “an unexpected event in which the participant comes to rest on the ground, floor, or lower level” [1]. Inpatient falls are the leading cause of hospital adverse events with incidence rate varying from 2.4 in large tertiary university hospitals to 9.1 in geriatric hospital departments per one thousand patient-days [1,2,3,4]. Two major types of fall risk factors were distinguished: (a) intrinsic factors comprising age, gender, musculoskeletal disorders, patient’s imbalance and using drugs; (b) extrinsic factors including the weaknesses of the health system in the medical equipment maintenance and design, human resources, communication, training, and team work [5]. Age > 85 years, the male sex, a recent fall, gait instability, agitation and/or confusion, new urinary incontinence or frequency, adverse drug reactions and neurological and cardiovascular instability are the predominant risk factors of inpatient falls [6,7].
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