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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)
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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

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