The Consequences of Falls in Acute and Subacute Hospitals in Australia That Cause Proximal Femoral Fractures

OBJECTIVES: To compare consequences for patients with proximal femoral fractures (PFFs) sustained in the hospital with patients who sustained PFFs in the community. DESIGN: Data were collected from inpatient notes and incident reports of patients admitted to hospitals over a 6‐year period. All patients aged 75 and older sustaining a PFF in the hospital were identified and matched according to sex, age, and fracture date with patients who sustained a PFF in the community. SETTING: Illawarra region hospitals, New South Wales, Australia. PARTICIPANTS: Forty‐three patients with a hospital‐acquired PFF and 43 patients with a community‐acquired PFF; mean age was 84.0 (range 75–92), and 67% were women. MEASUREMENTS: Outcomes at hospital discharge and circumstances of hospital‐acquired PFF. RESULTS: Comparing outcomes of subjects with hospital versus community‐acquired PFF revealed that 12 versus four died in the hospital ( P= .03), 14 versus five were discharged to long‐term nursing care facilities ( P= .02), six versus 18 returned to preadmission ambulation ( P= .004), and four versus 24 returned to preadmission activity of daily living status ( P <.001). The median postfracture length of stay was 46 days for subjects with hospital‐acquired PFF versus 32 days for those sustaining a PFF in the community ( P <.01). Review of circumstances of the 43 hospital‐acquired fractures revealed that 26 occurred in subacute wards, 25 occurred in bedrooms, 25 occurred at night, and 38 occurred while unsupervised. CONCLUSION: Patients with hospital‐acquired PFF have poor outcomes. Adequate supervision, provision of hip protectors in the hospital, and strategies that address fracture circumstances may hold the keys to prevention.