Objective: To quantify the additional hospital length of stay (LOS) and costs associated with in-hospital falls and fall injuries in acute hospitals in Australia.
Design, setting and participants: A multisite prospective cohort study conducted during 2011–2013 in the control wards of a falls prevention trial (6-PACK). The trial included all admissions to 12 acute medical and surgical wards of six Australian hospitals. In-hospital falls data were collected from medical record reviews, daily verbal reports by ward nurse unit managers, and hospital incident reporting and administrative databases. Clinical costing data were linked for three of the six participating hospitals to calculate patient-level costs.
Outcome measures: Hospital LOS and costs associated with in-hospital falls and fall injuries for each patient admission.
Results: We found that 966 of a total of 27 026 hospital admissions (3.6%) involved at least one fall, and 313 (1.2%) at least one fall injury, a total of 1330 falls and 418 fall injuries. After adjustment for age, sex, cognitive impairment, admission type, comorbidity and clustering by hospital, patients who had an in-hospital fall had a mean increase in LOS of 8 days (95% CI, 5.8–10.4; P < 0.001) compared with non-fallers, and incurred mean additional hospital costs of $6669 (95% CI, $3888–$9450; P < 0.001). Patients with a fall-related injury had a mean increase in LOS of 4 days (95% CI, 1.8–6.6; P = 0.001) compared with those who fell without injury, and there was also a tendency to additional hospital costs (mean, $4727; 95% CI, −$568 to $10 022; P = 0.080).
Conclusion: Patients who experience an in-hospital fall have significantly longer hospital stays and higher costs. Programs need to target the prevention of all falls, not just the reduction of fall-related injuries.
- 1. Shaw R, Drever F, Hughes H, et al. Adverse events and near miss reporting in the NHS. Qual Saf Health Care 2005; 14: 279-283.
- 2. Heinrich S, Rapp K, Rissmann U, et al. Cost of falls in old age: a systematic review. Osteoporos Int 2010; 21: 891-902.
- 3. Sari AB, Sheldon TA, Cracknell A, Turnbull A. Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review. BMJ 2007; 334: 79.
- 4. Haines TP, Cornwell P, Fleming J, et al. Documentation of in-hospital falls on incident reports: qualitative investigation of an imperfect process. BMC Health Serv Res 2008; 8: 254.
- 5. Hill AM, Hoffmann T, Hill K, et al. Measuring falls events in acute hospitals – a comparison of three reporting methods to identify missing data in the hospital reporting system. J Am Geriatr Soc 2010; 58: 1347-1352.
- 6. Morello RT, Barker AL, Haines T, et al. In-hospital falls and fall injuries: a protocol for a cost of fall study. Inj Prev 2013; 19: 363.
- 7. Bates DW, Pruess K, Souney P, Platt R. Serious falls in hospitalized patients: correlates and resource utilization. Am J Med 1995; 99: 137-143.
- 8. Zecevic AA, Chesworth BM, Zaric GS, et al. Estimating the cost of serious injurious falls in a Canadian acute care hospital. Can J Aging 2012; 31: 139-147.
- 9. Hill KD, Vu M, Walsh W. Falls in the acute hospital setting – impact on resource utilisation. Aust Health Rev 2007; 31: 471-477.
- 10. Barker A, Brand C, Haines T, et al. The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial. Inj Prev 2011; 17: e5.
- 11. Hauer K, Lamb SE, Jorstad EC, et al. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 2006; 35: 5-10.
- 12. Morse JM. The safety of safety research: the case of patient fall research. Can J Nurs Res 2006; 38: 73-88.
- 13. Australian Bureau of Statistics. Consumer Price Index, Australia. Canberra: ABS, 2013. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/6401.0Dec%202013?OpenDocument (accessed Sep 2014).
- 14. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36: 8-27.
- 15. Mihaylova B, Briggs A, O’Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Econ 2011; 20: 897-916.
- 16. Duan N, Manning WG, Carl N, et al. A comparison of alternative models for the demand for medical care. J Bus Econ Stat 1983; 1: 115-126.
- 17. Gettens S, Fulbrook P. Fear of falling: association between the Modified Falls Efficacy Scale, in-hospital falls and hospital length of stay. J Eval Clin Pract 2015; 21: 43-50.
- 18. Australian Commission on Safety and Quality in Health Care. Preventing falls and harm from falls in older people: best practice guidelines for Australian hospitals. Sydney: ACSQHC, 2009. http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-HOSP1.pdf (accessed Oct 2011).
- 19. National Institute for Health and Care Excellence. Falls: assessment and prevention of falls in older people. London: NICE, 2014. https://www.nice.org.uk/guidance/cg161 (accessed Apr 2014).
- 20. Lujic S, Watson DE, Randall DA, et al. Variation in the recording of common health conditions in routine hospital data: study using linked survey and administrative data in New South Wales, Australia. BMJ Open 2014; 4: e005768.
- 21. Henderson T, Shepheard J, Sundararajan V. Quality of diagnosis and procedure coding in ICD-10 administrative data. Med Care 2006; 44: 1011-1019.
- 22. Jackson T. Cost estimates for hospital inpatient care in Australia: evaluation of alternative sources. Aust N Z J Public Health 2000; 24: 234-241.
- 23. Cameron ID, Gillespie LD, Robertson MC, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012; 12: CD005465.
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