In-hospital falls: evaluation and response.
OBJECTIVE
: In-hospital falls are a significant source of morbidity in the inpatient setting and a common reason for neurologic consultation. Patients with neurologic disease are at increased risk for these falls. Neurologists should attempt to identify those who are at risk and mitigate risk using individualized and systemwide approaches.


RESULTS
: Organizations such as the Centers for Medicare & Medicaid Services and the Joint Commission have brought increased scrutiny on this serious issue. Care for in-hospital falls resulting in serious injury is no longer reimbursed by Medicare, and in-hospital falls represent sentinel events requiring investigation according to the Joint Commission. Even the best-performing fall risk stratification tools have limitations in both sensitivity and specificity. However, recent randomized trial data demonstrated the efficacy of targeted intervention to modifiable risk factors in reducing falls in the hospital.


CONCLUSIONS
: The combination of acute illness, patient vulnerability, and environmental factors in the hospital plays a critical role in determining fall likelihood. A systematic approach to identification of modifiable risk factors and application of measures designed to remove or compensate for them has the potential to reduce the burden of falls and their consequences. Careful evaluation of the patient who has fallen is important given the likelihood of harm in vulnerable patients as well as the potential for subtle presentations of serious injuries. It is incumbent on the practicing neurologist to be aware of the scope of the issue, the potential underlying risks in each patient, strategies to mitigate those risks, and how best to approach the patient who has fallen.
Ethan
E
Cumbler
David
D
Likosky