29% of adult patients who fall in the hospital suffer serious injury. There is little evidencebased literature to guide physicians when assessing hospitalized patients for fallrelated injury. This study was designed to (1) identify demographic and/or clinical factors which predict serious fallrelated injury among hospitalized adults, and (2) judge the adequacy of physician documentation related to adult patients who fell in the hospital.
Nursing staff are required to report all hospital falls through our hospital’s computerized Patient Safety Network (PSN). We performed a retrospective chart review of all PSN reported falls that occurred during 2010 in our 431bed university acute care hospital. Patients less than 18 years old, pregnant women, and prisoners were excluded.
Medical records were available for 286/293 (98%) of PSNreported falls in 251 eligible patients. Falls occurred in 152 males (61%) and 99 females (39%). 48% of falls occurred while toileting. 25% (63/286) of falls were associated with injury, and 4% (11/286) with serious injury (laceration requiring closure or fracture). Compared to all fallers, patients with injury did not differ by gender (males 38/152 vs females 25/99, P = 0.96). Patients older than 64 years who fell were no more likely to suffer injury that younger adults (13/64 vs 50/187, P = 0.31). In univariate analysis, patients who reported hitting their head, patients with prefall confusion, and patients who received narcotics on the day of fall were more likely to suffer injury (estimated odds ratios 6.04, 2.00, and 5.1, respectively). In multivariate analysis, receiving a narcotic on the day of fall was the strongest predictor of injury (Table). 33% (21/63) of falls with injury had no physician documentation in the hospital record, and in only 21% (13/63) of cases, were falls with injury mentioned in the discharge summary.
In this singleinstitution study, injury occurred in 25% of patients who fell, and serious injury in 4%. Compared to all falls, falls with injury did not vary by gender or age. Receiving a narcotic of the day of fall was the strongest predictor of injury. Physicians inconsistently provided medical record documentation of hospitalized patients who fell with injury.
Table 1Factors Predicting FallRelated Injury (n= 286 Falls)
|Name||Values||Estimate||95% Confidence Interval||Z statistic||Pvalue|
|Hit head||Yes vs. No||1.07||0.85||1.36||0.58||0.5629|
|Prefall confusion||Yes vs. No||1.74||0.99||3.08||1.91||0.0558|
|Received narcotic||Yes vs. No||5.59||2.14||14.65||3.51||0.0005|
To cite this abstract:Johnson E, Kang H, Pierce J, Shirley M. Fallrelated Injury in the Hospital. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97612. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/fallrelated-injury-in-the-hospital/. Accessed August 23, 2019.