Skip to main content

Advertisement

Log in

Characteristics and circumstances of falls in a hospital setting

A prospective analysis

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Halfon P, Eggli Y, Van Melle G, Vagnair A. Risk of falls for hospitalized patients: a predictive model based on routinely available data. J Clin Epidemiol. 2001;54:1258–66.

    Article  PubMed  CAS  Google Scholar 

  2. Lane AJ. Evaluation of the fall prevention program in an acute care setting. Orthop Nurs. 1999;18:37–43.

    Article  PubMed  CAS  Google Scholar 

  3. Roberts BL. Is a stay in an intensive care unit a risk for falls? Appl Nurs Res. 1993;6:135–6.

    Article  PubMed  CAS  Google Scholar 

  4. Morgan VR, Mathison JH, Rice JC, Clemmer DI. Hospital falls: a persistent problem. Am J Public Health. 1985;75:775–7.

    Article  PubMed  CAS  Google Scholar 

  5. Ash KL, MacLeod P, Clark LA. Case control study of falls in the hospital setting. J Gerontol Nurs. 1998;24:7–15.

    PubMed  CAS  Google Scholar 

  6. Morse JM, Prowse MD, Morrow N, Federspeil G. A retrospective analysis of patient falls. Can J Public Health. 1985;76:116–8.

    PubMed  CAS  Google Scholar 

  7. Bates DW, Pruess K, Souney P, Platt R. Serious falls in hospitalized patients: correlates and resource utilization. Am J Med. 1995;99:137–43.

    Article  PubMed  CAS  Google Scholar 

  8. Oliver D, Hopper A, Seed P. Do hospital fall prevention programs work? A systematic review. J Am Geriatr Soc. 2000;48:1679–89.

    PubMed  CAS  Google Scholar 

  9. Oliver D, Martin F, Seed P. Preventing patient falls. Age Ageing. 2002;31:75–6.

    Article  PubMed  Google Scholar 

  10. Hendrich AL, Bender PS, Nyhuis A. Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patients. Appl Nurs Res. 2003;16:9–21.

    Article  PubMed  Google Scholar 

  11. Frels C, Williams P, Narayanan S, Gariballa SE. Iatrogenic causes of falls in hospitalised elderly patients: a case-control study. Postgrad Med J. 2002;78:487–9.

    Article  PubMed  CAS  Google Scholar 

  12. Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ. 1997;315:1049–53.

    PubMed  CAS  Google Scholar 

  13. Gluck T, Wientjes HJ, Rai GS. An evaluation of risk factors for inpatient falls in acute and rehabilitation elderly care wards. Gerontology. 1996;42:104–7.

    PubMed  CAS  Google Scholar 

  14. Hendrich A, Nyhuis A, Kippenbrock T, Soja ME. Hospital falls: development of a predictive model for clinical practice. Appl Nurs Res. 1995;8:129–39.

    Article  PubMed  CAS  Google Scholar 

  15. Morse JM, Tylko SJ, Dixon HA. Characteristics of the fall-prone patient. Gerontologist. 1987;27:516–22.

    PubMed  CAS  Google Scholar 

  16. Tinetti ME, Doucette JT, Claus EB. The contribution of predisposing and situational risk factors to serious fall injuries. J Am Geriatr Soc. 1995;43:1207–13.

    PubMed  CAS  Google Scholar 

  17. 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;43:1214–21.

    PubMed  CAS  Google Scholar 

  18. Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. 1991;46:M164-M170.

    PubMed  CAS  Google Scholar 

  19. Gaebler S. Predicting which patient will fall again...and again. J Adv Nurs. 1993;18:1895–902.

    Article  PubMed  CAS  Google Scholar 

  20. Salgado R, Lord SR, Packer J, Ehrlich F. Factors associated with falling in elderly hospital patients. Gerontology. 1994;40:325–31.

    PubMed  CAS  Google Scholar 

  21. Lund C, Sheafor ML. Is your patient about to fall? J Gerontol Nurs. 1985;11:37–41.

    PubMed  CAS  Google Scholar 

  22. Stalenhoef PA, Diederiks JP, Knottnerus JA, de Witte LP, Crebolder HF. The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Fam Pract. 2000;17:490–6.

    Article  PubMed  CAS  Google Scholar 

  23. 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;133:1179–90.

    PubMed  CAS  Google Scholar 

  24. Kiely DK, Kiel DP, Burrows AB, Lipsitz LA. Identifying nursing home residents at risk for falling. J Am Geriatr Soc. 1998;46:551–5.

    PubMed  CAS  Google Scholar 

  25. Mayo NE, Korner-Bitensky N, Levy AR. Risk factors for fractures due to falls. Arch Phys Med Rehabil. 1993;74:917–21.

    PubMed  CAS  Google Scholar 

  26. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002;346:1715–22.

    Article  PubMed  Google Scholar 

  27. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987–93.

    Article  PubMed  Google Scholar 

  28. Unruh L. Licensed nurse staffing and adverse events in hospitals. Med Care. 2003;41:142–52.

    Article  PubMed  Google Scholar 

  29. Blegen MA, Vaughn T. A multisite study of nurse staffing and patient occurrences. Nurs Econ. 1998;16:196–203.

    PubMed  CAS  Google Scholar 

  30. Sovie MD, Jawad AF. Hospital restructuring and its impact on outcomes: nursing staff regulations are premature. J Nurs Admin. 2001;31:588–600.

    Article  CAS  Google Scholar 

  31. Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health. 2002;56:631–6.

    Article  PubMed  CAS  Google Scholar 

  32. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7.

    Article  PubMed  CAS  Google Scholar 

  33. Fletcher PC, Hirdes JP. Risk factors for falling among community-based seniors using home care services. J Gerontol A Biol Sci Med Sci. 2002;57:M504-M510.

    PubMed  Google Scholar 

  34. Nygaard HA. Falls and psychotropic drug consumption in long-term care residents: is there an obvious association? Gerontology. 1998;44:46–50.

    Article  PubMed  CAS  Google Scholar 

  35. Morse JM. Enhancing the safety of hospitalization by reducing patient falls. Am J Infect Control. 2002;30:376–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Melissa J. Krauss MPH or Victoria J. Fraser MD.

Additional information

This study was supported by grant U 18HS 1189801 from the Agency for Healthcare Research and Quality.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hitcho, E.B., Krauss, M.J., Birge, S. et al. Characteristics and circumstances of falls in a hospital setting. J GEN INTERN MED 19, 732–739 (2004). https://doi.org/10.1111/j.1525-1497.2004.30387.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30387.x

Key words

Navigation