Preventing Fall-Related Injuries

Falls are an unfortunate aspect of life that particularly plague older adults. Every year, more than one in four older adults experiences a fall, and one in five of those who fall suffers a serious injury. Approximately 800,000 older adults will be hospitalized each year with a fall-related injury, usually a head injury or a fractured hip. (CDC "Important Facts") In addition, an estimated 700,000 to 1,000,000 patients fall in hospitals each year (AHRQ). The cost of falls in 2015 was estimated at $50 billion. Alarmingly, between 2007 and 2016 the rate of death due to fall-related injuries rose 3% per year on average for older adults (Burns and Kakara).

Because many healthcare facilities treat more older adults than other segments of the population, facilities must contend with this background falls rate. The problem is compounded for acute care hospitals because the treatments provided may increase the patient's risk of falling. The problem is also consequential for long-term care facilities because they can no longer perform the types of interventions (e.g., restraints) that were once commonly used to keep residents from falling, and because it is sometimes necessary to administer medications that may improve the resident's health or quality of life, but increase his or her risk of falling.

How big is the problem for healthcare facilities? In published studies, researchers and individual organizations have reported falls rates that have not changed substantially in recent years. A 2004 study reported falls among hospital inpatients ranging from 2.3 to 7 falls per 1,000 patient-days (Hitcho et al.). In 2002, Barnes-Jewish Hospital in St. Louis, Missouri, reported a hospital-wide fall rate of 3.29 per 1,000 patient-days (Krauss et al.).

However, these falls rates are not meaningful if a facility's data are not risk adjusted in the same way as the data with which they are compared. The organization's definition of a fall, reporting policies, and method of calculating falls rates (falls per bed, per patient, per patient-day, or per patient-year) must also be considered. Population mix and type of care unit must be considered as well so that the organization is comparing populations—such as acute, behavioral, rehabilitation, or geriatric care—that are in fact comparable.

A study of the data in the National Database of Nursing Quality Indicators, a proprietary database of the American Nurses Association, looked at a large sample of patient encounters in a total of 6,100 nursing units (1,949 medical; 1,530 surgical; and 2,621 medical-surgical) between July 1, 2006, and September 30, 2008. These units represented 1,263 hospitals. Overall, the falls rate during the study period was 3.56 per 1,000 patient-days and the rate of falls with injury was 0.93 per 1,000 patient-days. Difference among the types of units studied included the following (values are per 1,000 patient-days):

The authors noted that the rate of injury from falls was fairly steady at approximately one in four. Although neurosurgery and neurology units were not included in the study, the authors noted that patients in these units tend to have higher rates of falls, while surgery and intensive care units tend to have lower rates of falls. (Bouldin...