Inpatient falls cause harm to one in three

“Falls are the most common accident in hospitals and they are on the increase because the population is ageing. This is a major challenge to patient safety, which is the patient's fundamental right," says Development Manager Anniina Heikkilä, MSc (Health Sciences), from Nursing management at HUS. Her doctoral dissertation was examined at the University of Helsinki in June.

HUS examined the incidence, risk and consequences of inpatient falls in hospitals. In addition, the reliability of the FRAT indicator (Penisula Health Falls Risk Assessment Tool) used in specialized medical care in Finland was evaluated. Inpatient falls in hospitals are a worldwide problem, but their prevalence in specialized health care, different disease groups and different specialties has not been studied in Finland before.

In the study, one third of the patients who fell during their hospital stay suffered harm as a result of the fall. The injuries were mainly to the head area and the most common symptoms were pain and confusion.

The falls usually occurred at the beginning of the treatment and their number varied according to specialty and diagnosis group: neurological patients fell most often and surgical patient least often.

The factors predicting falling in hospital were high age, a prolonged hospital stay, a neurological disease and the patient’s arrival from another hospital or from the emergency department. The risk of falling was also increased by the following secondary diagnoses: dementia, pneumonia, and especially the harmful effects of alcohol use.

Hospital stays were prolonged and mortality increased

Falling prolonged the length of the hospital stay: in somatic care, hospitalizations were four days longer and in psychiatric care, 17 days longer than in the control group. The risk of falling also increased the costs of treatment.

Inpatient falls significantly increased in-hospital mortality and all-cause mortality after discharge from hospital. Patients’ hospital mortality was on average 0.6%, while it was 2.9% in the groups of those who fell. In the one-year follow-up, 35% of those who fell died.

Quality of nursing is measured by the number of falls

At HUS, the quality of nursing is assessed for example by monitoring the number of pressure ulcers and inpatient falls. The objective set at HUS is to assess the fall risk for 80% of patients coming to inpatient wards.

A high fall risk in the FRAT indicator used in the assessment increased the probability of falling to almost threefold compared with low-risk patients. However, in the study, the FRAT indicator proved to be moderately reliable only in the specialties of internal medicine, neurology and oncology, although it was fairly poor even in them.

“If an extensive fall risk assessment in accordance with the international recommendation were conducted with every patient over the age of 65 at HUS, the annual workload of almost ten nurses would be required. There is no capacity for that. The FRAT indicator currently in use must therefore be developed and its content may have to be extended,” summarizes Anniina Heikkilä.

The research data consisted of the patient records of 114,951 adult patients treated on HUS’s inpatient wards, a staff survey and the data in Statistics Finland’s mortality register for the period 2014–2016. The research methods used were cross-sectional, cohort and descriptive methods. The information on the cause of death within a year from discharge was received from Statistics Finland. Nurses also collected information from the FRAT indicator in twelve HUS units. Of the patients in the study, 22,700 had been assessed with the FRAT indicator and 14% of them were at risk of falling.

Research article: Inpatient falls in adult acute care – risk assessment, risk factors and consequences (helsinki.fi) for the dissertation Inpatient falls in adult acute care – risk assessment, risk factors and consequences.