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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.'


Presented at Society of Hospital Medicine, 04/02/2012, San Diego, CA. J Hosp Med 2012;7(Suppl 2):S48.