Improving the capture of fall events in hospitals: combining a service for evaluating inpatient falls with an incident report system.
OBJECTIVE
To determine the utility of a fall evaluation service to improve the ascertainment of falls in acute care.


METHODS
Six-month observational study.


METHODS
Sixteen adult nursing units (349 beds) in an urban, academically affiliated, community hospital.


METHODS
Patients admitted to the study units during the study period.


METHODS
Nursing staff identifying falls were instructed to notify, using a pager, a trained nurse "fall evaluator." Fall evaluators provided 24-hour-per-day 7-day-per-week coverage throughout the study. Data on patient falls gathered by fall evaluators were compared with falls data obtained through the hospital's incident reporting system.


RESULTS
During 51,180 patient-days of observation, 191 falls were identified according to incident reports (3.73 falls/1,000 patient-days), whereas the evaluation service identified 228 falls (4.45 falls/1,000 patient-days). Combining falls reported from both data sources yielded 266 falls (5.20 falls/1,000 patient-days), a 39% relative rate increase compared with incident reports alone (P<.001). For falls with injury, combining data from both sources yielded 79 falls (1.54 injurious falls/1,000 patient-days), compared with 57 falls (1.11 injurious falls/1,000 patient-days) filed in incident reports--a 28% increase (P=.06). In the 16 nursing units, the relative percentage increase of captured fall events using the combined data sources versus the incident reporting system alone ranged from 13% to 125%.


CONCLUSIONS
Incident reports significantly underestimate both injurious and noninjurious falls in acute care settings and should not be used as the sole source of data for research or quality improvement initiatives.
Shorr
Ronald I
RI
Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida 32608, USA. RShorr@aging.ufl.edu
Mion
Lorraine C
LC
Chandler
A Michelle
AM
Rosenblatt
Linda C
LC
Lynch
Debra
D
Kessler
Lori A
LA
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012308:Risk Management / Q000639:trends*; D013714:Tennessee / Q000453:epidemiology