Identification of the patient at risk for a fall related injury in an acute care setting: A retrospective study

Abstract

Objective: The aim of this study was to identify the patient at risk for a fall-related injury while receiving care in an acute healthcare setting. The prevention of patient falls in hospital settings has been identified as an international patient safety goal. Despite a myriad of validated assessment tools, falls do occur.
Methods: Using a retrospective study design, the medical records of patients who encountered a fall-related injury were reviewed, with demographic and situational variables included in the study data set.
Results: Frequency and descriptive analyses were performed on the study population that fell, then sub-grouped by level of fall-related injury. These results were correlated to the results of the routinely used fall assessment tool and to the research literature.
Conclusions: The study concluded that an assessment tool has value in identifying the patient at risk for a fall but is limited in the ability to identify the patient at risk for a fall related injury. Advanced age does increase the risk for a fall-related injury, especially if the patient is taking antidepressive medications or has been diagnosed with Parkinson’s Disease. Women appear to have a slight propensity toward fall-related injuries. The overall length of hospital stay is prolonged as a result of the fall, and the ability to return to a private home is at risk. The design of this study consisted of data from patients and investigated due to caregivers’ desire to decrease these scenarios. Fall-related major injuries, while rare, demonstrate vague identifiable variables, not predictable using present-day assessment tools.

Keywords

Patient falls / Fall assessments / Retrospective study / Fall-related injuries / Acute care

References

[1] World Health Organization. Falls. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/falls/

[2] National Database of Nursing Quality Indicators. Guidelines for data collection and submission on care coordination in ambulatory settings. Elkridge, MD: Press Ganey; 2014.

[3] Joint Commission.International Patient Safety Goals. Joint Commission International. 2017. Available from: https://www.jointcommissioninternational.org/standards/international-patient-safety-goals/

[4] Joint Commission.Sentinel event data released for 2023. 2024. Available from: https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/2024/2024_sentinel-event-_annual-review_published-2024.pdf

[5] Agency for Healthcare Research and Quality, US Department of Health and Human Services. Falls. PSNet [internet]. Rockville (MD); 2024. Available from: https://psnet.ahrq.gov/primer/falls

[6] Morris M, Webster K, Jones C, et al. Interventions to reduce falls in hospitals: a systematic review and meta-analysis, Age and Ageing. 2023; 51(5): afaco77. PMid: 35524748. https://doi.org/10.1093/ageing/afac077

[7] Burns Z, Khasnabish S, Hurley AC, et al. Classification of Injurious Fall Severity in Hospitalized Adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2020; 75(10): e138-e144. PMid: 31907532. https://doi.org/10.1093/gerona/glaa004

[8] Centers for Medicare and Medicaid Services.Electronic clinical quality measures basics. 2022. Available from: https: //www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures

[9] Aranda-Gallardo M, Morales-Asencio JM, Canca-Sanchez JC, et al. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC Health Services Research. 2013; 2(13): 122. PMid: 23547708. https://doi.org/10.1186/1472-6963-13-122

[10] Kim YJ, Choi KO, Ch, SH, et al. Validity of the Morse Fall Scale and the Johns Hopkins Fall Risk Assessment Tool for fall risk assessment in an acute care setting. Journal of Clinical Nursing. 2022; 31(23-24): 3584-3594. PMid: 34964175. https://doi.org/10.1111/jocn.16185

[11] Randell R, McVey L, Wright J, et al. Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. Health and Social Care Delivery Research. 2024; 12(5): 1-194. https://doi.org/10.3310/JWQC5771

[12] Locklear T, Kontos J, Brock CA, et al. Inpatient Falls: Epidemiology, Risk Assessment, and Prevention Measures. A Narrative Review. HCA Healthcare Journal of Medicine. 2024; 5(5): 517-525. PMid: 39524960. https://doi.org/10.36518/2689-0216.1982

[13] Yoshikawa A, Ramirez G, Smith ML, et al. Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2020; 75(10): 1989-1995. PMid: 32016284. https://doi.org/10.1093/gerona/glaa038

[14] Warren C, Rizo E, Decker E, et al. A Comprehensive Analysis of Risk Factors Associated With Inpatient Falls. Journal of Patient Safety. 2023; 19(6): 396-402. PMid: 37186671. https://doi.org/10.1097/PTS.0000000000001123

[15] Heikkilä A, Lehtonen L, Junttila K. Fall rates by specialties and risk factors for falls in acute hospital: A retrospective study. Journal of Clinical Nursing, 2023; 32(15-16): 4868-4877. PMid: 36478598. https://doi.org/10.1111/jocn.16594

[16] Hasan B, Bechenat D, Bethel HM, et al. A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections. Mayo Clin Proceedings of Innovated Quality Outcomes. 2025; 9(3): 100607. PMid: 40256621. https://doi.org/10.1016/j.mayocpiqo.2025.100607

[17] Noori R, Khajavian N, Sadeghmoghadam L, et al. The fall risk assessment and correlated factors among elderly inpatients in 2020: A cross sectional study. Iranian Rehabilitation Journal. 2023; 21(4): 703-710. https://doi.org/10.32598/irj.21.4.1921.1

[18] Poe SS, Dawson PB, Cvach M, et al. The Johns Hopkins Fall Risk Assessment Tool: A Study of Reliability and Validity. Journal of Nursing Care Quality. 2018; 33(1): 10-19. PMid: 28968337. https://doi.org/10.1097/NCQ.0000000000000301

[19] IBM Corp.SPSS Statistics for Windows, Version 29.0.2.0. Armonk, NY: IBM Corp; 2023.

[20] National Database of Nursing Quality Indicators.Guidelines for Data Collection and Submission on Patient Falls Indicator. 2020. Available from: https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/guide.html

[21] Trinh LTT, Assareh H, Wood M, et al. Falls in Hospital Causing Injury. Journal for healthcare quality: official publication of the National Association for Healthcare Quality. 2020; 42(1): 1-11. PMid: 30649003. https://doi.org/10.1097/JHQ.0000000000000179

[22] Strini V, Schiavolin R, Prendin A. Fall Risk Assessment Scales: A Systematic Literature Review. Nursing reports (Pavia, Italy). 2021; 11(2): 430-443. PMid: 34968219. https://doi.org/10.3390/nursrep11020041

[23] Centers for Disease Control and Prevention.Older adult fall data. 2024. Available from: https://www.cdc.gov/falls/data-research/index.html

[24] Virnes RE, Tiihonen M, Karttunen N, et al. Opioids and Falls Risk in Older Adults: A Narrative Review. Drugs Aging. 2022; 39(3): 199-207. PMid: 35288864. https://doi.org/10.1007/s40266-022-00929-y

[25] Allen N E, Canning CG, Almeida LRS, et al. Interventions for preventing falls in Parkinson’s disease. The Cochrane Database of Systematic Reviews. 2022; 6(6): CD011574. PMid: 35665915. https://doi.org/10.1002/14651858.CD011574.pub2

[26] Lohman MC, Fairchild AJ, Merchant AT. Antidepressant Use Partially Mediates the Association Between Depression and Risk of Falls and Fall Injuries Among Older Adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2021; 76(9): e171-e178. PMid: 33017840. https://doi.org/10.1093/gerona/glaa253

[27] Appeadu MK, Bordonib B. Fall and Fall Prevention in Older Adults. In: StatPearls [Internet] Treasure Island (FL); 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560761/