Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care

Abstract

Background Many hospitals classify inpatient falls as assisted (if a staff member is present to ease the patient’s descent or break the fall) or unassisted for quality measurement purposes. Unassisted falls are more likely to result in injury, but there is limited research quantifying this effect or linking the assisted/unassisted classification to processes of care. A study was conducted to link the assisted/unassisted fall classification to both processes and outcomes of care, thereby demonstrating its suitability for use in quality measurement. This was only the second known published study to quantify the increased risk of injury associated with falling unassisted (versus assisted), and the first to estimate the effects of falling unassisted (versus assisted) on the likelihood of specific levels of injury. Methods A cross-sectional analysis of falls from all available 2011 data for 6,539 adult medical, surgical, and medical-surgical units in 1,464 general hospitals participating in the National Database of Nursing Quality Indicators® (NDNQI®) was performed. Results Participating units reported 166,883 falls (3.44 falls per 1,000 patient-days). Excluding repeat falls, 85.5% of falls were unassisted. Assisted and unassisted falls were associated with different processes and outcomes: Fallers in units without a fall prevention protocol in place were more likely to fall unassisted than those with a protocol in place (adjusted odds ratio [aOR], 1.39 [95% confidence interval (CI), 1.32, 1.46]), and unassisted falls were more likely to result in injury (aOR, 1.59 [95% CI, 1.52, 1.67]). Conclusions The assisted/unassisted fall classification is associated with care processes and patient outcomes, making it suitable for quality measurement. Unassisted falls are more likely than assisted falls to result in injury and should be considered as a target for future prevention efforts.

‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation

“…Previous studies, including an analysis of a large US national data set of over 165 000 falls, have demonstrated that over 85% of falls are not witnessed;2 therefore, patients need to be aware of how to initiate activities safely on the ward, when not in the immediate presence of assisting staff. Other researchers have also stated that if hospital falls prevention is to be effective, it is vital that patients are considered part of the team,25 26 33 34 and that the falls prevention plan should be communicated directly to the patient and their family 27…”

“…Over 30% of hospital falls cause physical injury2 and it is estimated that inpatient falls cost the UK healthcare system more than GBP £15 million per year 3. In Australia, over 33 000 falls that resulted in patient harm were reported from health services in 2014–2015 4.…”

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

“…Just three of the 16 hospitals used this definition prior to the study (Table ). Levels of injury collected on the form ranged from minor harm to death and were consistent with those used by the National Database of Nursing Quality Indicators …”

“…This initial gap analysis assessed presence vs absence of processes only. The education emphasized reporting assisted falls as system successes because assisted falls are less likely to result in injury than unassisted falls and reporting assisted falls provides feedback about the effectiveness of training core team members in safe transfers/mobility. This training facilitates early mobilization of patients, which is essential to prevent secondary functional decline, and it should include principles of postural control, bed mobility, body mechanics, use of devices and lifts, and techniques to assist gait …”

Bayesian and frequentist approaches to assessing reliability and precision of health-care provider quality measures

“…The nursing units are the health care providers in this context, and the frequency with which unassisted falls occur on the unit is the measure of quality. 9 Two aspects of the application are somewhat unusual: the data set contains one observation per unit rather than multiple (clustered) observations per unit, and the analyses do not involve mixed models. Gajewski et al 10 discussed empirical Bayes and Bayesian hierarchical model approaches to quality measurement using similar data but did not address reliability.…”