Characteristics and consequences of falls, and preventive interventions in hospitalised patients: A cohort study

Introduction In-hospital falls are common, particularly among elderly patients. These falls can result in physical, psychological, social, and financial negative outcomes. The aim was to explore fall characteristics, physical consequences, and preventive interventions in hospitalised adult patients. Methods At a teaching hospital, 31,571 episodes of care constituted the study population. A stratified sampling method with five groups was used. The study cohort consisted of 1,232 episodes of care; each reviewed in the electronic patient record using a study-specific protocol. Results After adjusting for the sampling technique, the cumulative incidence of falls in the study population was 1.9%. Furthermore, falls per 100 episodes of care and per 1,000 patient days were 2.3 and 4.9, respectively. In 590 episodes of care included in the study cohort, 714 (minimum-maximum 1–7) falls were identified. Two thirds of fallers were identified on admission as at risk. Fallers were often male (p = 0.041), older (p < 0.001), admitted acutely (p = 0.01), had a longer length of stay (p < 0.001), and were admitted to a medical specialty (p = 0.001). Falls were more frequent on weekdays (12.9%–17.1%) and during night shifts (37.7%). The most common location was the patient’s room (48.0%), and the most common position was when walking upright (28.9%). Of patients assessed as fall-risk individuals at admission, 58.2% had ≥ 1 documented fall-preventive intervention. In total, 1,933 interventions were prescribed, most commonly environmental adaptations, personal assistance during mobilisation, and use of non-slip socks or shoes. Most falls (60.1%) caused no harm; injuries were usually minor, including pain, wounds, and hematoma/swelling. Median time to first fall was 2 days (95% confidence interval 1.0–2.0). Elective patients fell earlier than acute patients. Conclusion Understanding falls can increase knowledge and advance care. Despite fall-preventive interventions, falls persists. Personalised, evidence-based interventions, particularly early in hospitalisation and at night, may reduce falls and improve outcomes.