Consistent differences in medical unit fall rates: implications for research and practice.
OBJECTIVE
To determine the proportion of variation in long-term fall rates attributable to variability between rather than within hospital units and to identify unit- and hospital-level characteristics associated with persistently low- and high-fall units.


METHODS
Retrospective study of administrative data on inpatient falls. Eighty low-fall and 74 high-fall units were identified based on monthly rankings of fall rates. Unit- and hospital-level characteristics of these units were compared.


METHODS
U.S. general hospitals participating in the National Database of Nursing Quality Indicators.


METHODS
Nonsubspecialty medical units (n=800) with 24 consecutive months of falls data.


METHODS
Monthly self-reported unit fall rates (falls per 1,000 patient-days).


RESULTS
An estimated 87% of variation in 24-month fall rates was due to between-unit differences. With the exception of patient-days, a proxy for unit bed size, low- and high-fall units did not differ on nurse staffing or any other unit or hospital characteristic variable.


CONCLUSIONS
There are medical units with persistently low and persistently high fall rates. High-fall units had higher patient volume, suggesting patient turnover as a variable for further study. Understanding additional factors underlying variability in long-term fall rates could lead to sustainable interventions for reducing inpatient falls.
Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.|Department of Pediatrics, University of Missouri- Kansas City, Kansas City, Missouri.
Vincent S
VS
Staggs
Vanderbilt University School of Nursing, Nashville, Tennessee.
Lorraine C
LC
Mion
Department of Epidemiology, University of Florida, Gainesville, Florida.|Geriatric Research, Education and Clinical Center, Malcom Randall Veterans Administration Medical Center, Gainesville, Florida.
Ronald I
RI
Shorr
D000058:Accidental Falls / Q000706:statistics & numerical data*; D035843:Biomedical Research; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D012189:Retrospective Studies
accidental falls; nursing; patient safety