Background: 2 — 9% of adult patients who fall in the hospital suffer serious injury. There is little evidence-based literature to guide physicians when assessing hospitalized patients for fall-related injury. This study was designed to (1) identify demographic and/or clinical factors which predict serious fall-related injury among hospitalized adults, and (2) judge the adequacy of physician documentation related to adult patients who fell in the hospital. Methods: Nursing staff are required to report all hospital falls through our hospitals computerized Patient Safety Network (PSN). We performed a retrospective chart review of all PSN reported falls that occurred during 2010 in our 431-bed university acute care hospital. Patients less than18 years old, pregnant women, and prisoners were excluded. Results: Medical records were available for 286/293 (98%) of PSN-reported 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 pre-fall 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, respectfully). 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. Conclusions: In this single-institution 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.'
Shirley, M; E Johnson; H Kang; and J Rush Pierce Jr. "Fall-related injury in the hospital." (2014). http://digitalrepository.unm.edu/hostpitalmed_pubs/14