Introduction Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1000 patient bed days1. Around 30% of falls as inpatient are injurious2. Falls are associated with a longer length of stay in hospital and greater utilization of healthcare facilities3. Objective The goal of this study is to describe patient characteristics, circumstances of fall and clinical outcomes after inpatient fall Methodology This is a retrospective, descriptive study of all patients admitted to the Medical Department in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL. Results 162 patients, with an average age of (61.82±15.50) years were included in this study. Of these, 103(63.58%) were male and 74(45.68%) were ≥65 years. 120(74.1%) were walking unaided prior to admission. 146(90.1%) patients were admitted with an acute medical illness and 13(8.0%) with an acute fall. Median time to first fall was 5(IQR 3-8) days after admission. 160(98.77%) falls occurred in the ward. 79(48.77%) falls occurred between 9:00pm to 6:59am. 75(46.3%) patients fell near their bed and 56(34.6%) fell in the toilet. 47(29.01%) had an injurious fall; 32(19.7%) had minor injury, 9(5.6%) had moderate injury and 6(3.7%) had severe injury. Patients with injurious falls were more likely to have “Direct Impact to Head” during fall [OR; 12.73 (95%CI 5.62 – 28.82)]. They were also more likely to have a Head CT after fall [(OR; 6.41 (95%CI 3.02 – 13.62)]. 18(11.1%) patients died during hospitalisation. Median time to death was 9(IQR 4-16.25) days after fall. 144(88.9%) patients were discharged alive at median 6(IQR 3.75 – 9.25) days after fall. Upon discharge, only 49(30.2%) patients were walking unaided. Conclusion Inpatient falls affects patients of all age groups, regardless of gender. Our data shows that Inpatient falls can cause increased morbidity due to falls related injuries; however, there is no difference in age, gender, length of stay or death as inpatient between patients with injurious and non-injurious falls.
Introduction Falls are a leading cause of hospital acquired injuries. Junior doctors play a role as part of the multidisciplinary team, to prevent in-hospital falls and reduce harm following a fall. This study is to determine junior doctors’ level of knowledge regarding in-hospital falls. Methods A self-constructed and validated questionnaire was delivered to junior doctors during their weekly teaching session in the first 2weeks of May2019. It comprised of 1) Demography of participants 2) In- hospital falls prevention 3) In-hospital falls management. Correct responses from junior doctors working less than 1year and those more than 1year were compared. Results 46% of the junior doctors responded to the questionnaire. Only 9.5% (n=23) had exposure to a course on management of falls. 82% of them (n=218) were not aware of Malaysia National Falls Guideline, whilst only a quarter of the responders (n=67) heard about the presence of Fall Intervention Team. Less than 50% junior doctors were aware of the use of Morse Fall Scale as a standardised risk assessment tool. More than 50% of the correct responses are from more experienced junior doctors. 63.4% answered “Depression is a risk factor for falls” correctly, which represented the lowest of all the items. The second lowest item was “lines/catheters is a risk factor for falls”. The item which had the highest percentage of correct answers was “dizziness/vertigo is a risk factor for falls”, accounting for 260 subjects (98%). 56% of housemen considered physical restraints as part of fall intervention in hospital. Conclusion The more experienced junior doctors had better knowledge about falls in the hospital, however from this study it is shown that it is still lacking. Continuing medical education should be an avenue where in-hospital falls is emphasized, and their knowledge is regularly updated.
Introduction Inpatient falls are associated with serious and life–threatening injuries in 4-6% of cases1. This includes Intracranial Injury (ICI). Imaging of the Head is required to detect and manage patients with head injury2; however there are no specific guidelines to facilitate utilisation of Head CT after Inpatient Falls. Objective The goal of this study is to review the utilisation of Head CT to determine rates of intracranial injury (ICI) following inpatient falls. Methodology This is a retrospective study of all patients admitted to the Medical Department, HKL in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL and review of medical notes. Results 152 patients, with an average age of (61.65±15.51) years were included in this study. Of these 94 (61.8%) were male, 85 (55.9%) were ≥ 65 years. 45 (29.6%) patients had a Head CT after inpatient fall. Median time to request for Head CT was 130 (IQR 30–582.50) minutes from the time of fall. Head CT was more likely in patients with Direct impact to head during fall (Adj.OR;4.71(95%CI 1.39 – 15.85). Fifty-seven (37.5%) patients sustained Direct impact to head during fall, however only 32/57(71.1%) had a Head CT as inpatient. Patients who had Direct impact to head during fall, were more likely to develop Giddiness (Adj.OR;5.96(95%CI 1.94-18.30) and Hematoma (Adj.OR;6.186(95%CI 1.59 – 24.03) after fall. Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT. Patients with (ICI) had an average age of (74.00 ±7.906) years. All 5 patients were reviewed by the Neurosurgical team. Of these, 1/5 (20%) patient died during hospitalisation and 1/5 (20%) patient was discharged in a terminally ill condition. Conclusion Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT and they were more likely to be ≥ 65years. Head CT was more likely in patients with Direct impact to head, headache, hematoma and confusion after inpatient fall.
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