In this article, Rehabilitation Expert, Christian Mongrain discusses falls in the health care setting. He covers the impact of falls, why they occur, and best demonstrated practices utilized by health care professionals to reduce the incidence and severity of fall incidents.
Falls are the most common adverse event reported in hospitals. According to the National Quality Measures Clearinghouse, falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays. Review of observational studies in acute care hospitals show that fall rates range from 1.3 to 8.9 falls/1,000 patient days. Falls occur at higher rates (8.9 to 17.1 falls/1,000 patient days) in units that focus on eldercare, neurology and rehabilitation. The Institute for Health Care Improvement has identified falls as the leading cause of death in people 65 and older, with 10% of fatal falls for the elderly occurring in hospitals.
Falls resulting in injuries in the health care setting are on the rise. Depending on the setting, as many as 15% of inpatients experience at least one fall, and The Joint Commission estimates that 30% of falls in health care settings result in serious injury. Most falls in health care settings are multifactorial and require investigation of an experienced expert to identify factors causing the fall, and to determine if standards of care were provided to prevent it.
How are Falls defined in a hospital setting?
The National Quality Forum (NQF) defines a fall as an unplanned descent to the floor (or extension of the floor e.g., trash can or other equipment) with or without injury to the patient.
Why do people fall?
Risk factors associated with falls can be categorized as either Intrinsic or Extrinsic. Intrinsic factors include physiologic impairments that may be pre-existing due to a person’s past medical history, or new as they relate to the reason for admission. Extrinsic factors relate to the environment occupied.
To understand falls, one must first understand balance. Humans balance by taking input (received through vision, sensation, equilibrium, and proprioception), then processing it (in the brain), and then reacting via an output mechanism (such as moving one’s head, limbs, trunk, or eyes). When a person has a reduction in their ability to receive, process, or react appropriately to stimuli, they are more likely to lose their balance and fall.
Falls have consequences
The cost of falls cannot only be measured by direct medical costs. People may also suffer from long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life.
What are health care providers doing?
Not every fall can be predicted or prevented. Many institutions apply techniques to identify patients at risk for falls and at risk of injury from falls, and then implement measures to prevent falls or reduce risk from injury. This may include one or more of the following techniques:
Through the effective development of fall prevention policies and procedures it is possible for health care facilities to reduce the incidence and severity of fall events. The health care experts at Robson Forensic are frequently retained to investigate disputes involving the adequacy of patient care and supervision. Contact our experts directly to discuss your case and how Robson Forensic can assist.
The experts at Robson Forensic are frequently retained to investigate the adequacy of care provided in hospitals, nursing homes and other health care facilities. Our experts can address many aspects of these cases from administrative policies and procedures, to the level of care provided by health care professionals, or the maintenance and custodial practices of care facilities.
For more information visit our Health Care Supervision practice page.