The extra resource burden of in-hospital falls: a cost of falls study

Renata T Morello, Anna L Barker, Jennifer J Watts, Terry Haines, Silva S Zavarsek, Keith D Hill, Caroline Brand, Catherine Sherrington, Rory Wolfe, Megan A Bohensky and Johannes U Stoelwinder
Med J Aust 2015; 203 (9): 367. || doi: 10.5694/mja15.00296


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.

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  • Renata T Morello1
  • Anna L Barker1
  • Jennifer J Watts1
  • Terry Haines1
  • Silva S Zavarsek1
  • Keith D Hill3
  • Caroline Brand4
  • Catherine Sherrington5
  • Rory Wolfe1
  • Megan A Bohensky4
  • Johannes U Stoelwinder1

  • 1 Monash University, Melbourne, VIC
  • 2 Deakin University, Melbourne, VIC
  • 3 Curtin University, Perth, WA
  • 4 University of Melbourne, Melbourne, VIC
  • 5 University of Sydney, Sydney, NSW



This study was funded as part of a larger falls prevention project, the 6-PACK project, by the National Health and Medical Research Council (APP1007627). Additional funding was provided by the Victorian Department of Health. Renata Morello was supported by an NHMRC postgraduate scholarship (APP1055604), Anna Barker by an NHMRC Career Development Fellowship (APP1067236), Catherine Sherrington by an NHMRC Career Development Fellowship (APP632929), and Terry Haines by an NHMRC Career Development Fellowship (APP1069758). We acknowledge Sheral Rifat and Elysia Greenhill for their assistance with data management. The study could not have been completed without the collaboration and support of the participating hospitals, their data analyst units and our data collection staff. Special thanks are also extended to Gigi Chan (Decision Support, Eastern Health) for providing valuable information on the hospital clinical costing systems and hospital costing data.

Competing interests:

No other relevant disclosures.

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