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Falls Among Adult Patients Hospitalized in the United States: Prevalence and Trends

Bouldin, Erin L. D. MPH*†; Andresen, Elena M. PhD†‡; Dunton, Nancy E. PhD§; Simon, Michael PhD, MSN; Waters, Teresa M. PhD; Liu, Minzhao MS**; Daniels, Michael J. PhD**; Mion, Lorraine C. RN, PhD, FAAN††; Shorr, Ronald I. MD, MS‡‡§§

doi: 10.1097/PTS.0b013e3182699b64
Original Articles
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Objectives The purpose of this study was to provide normative data on fall prevalence in U.S. hospitals by unit type and to determine the 27-month secular trend in falls before the implementation of the Centers for Medicare and Medicaid Service (CMS) rule, which does not reimburse hospitals for care related to injury resulting from hospital falls.

Methods We used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006, and September 30, 2008, to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical, and surgical nursing units. More than 88 million patient days (pd) of observation were contributed from 6100 medical, surgical, and medical-surgical nursing units in 1263 hospitals across the United States.

Results A total of 315,817 falls occurred (rate = 3.56 falls/1000 pd) during the study period, of which, 82,332 (26.1%) resulted in an injury (rate = 0.93/1000 pd). Both total fall and injurious fall rates were highest in medical units (fall rate = 4.03/1000 pd; injurious fall rate = 1.08/1000 pd) and lowest in surgery units (fall rate = 2.76/1000 pd; injurious fall rate = 0.67/1000 pd). Falls (0.4% decrease per quarter, P < 0.0001) and injurious falls (1% decrease per quarter, P < 0.0001) both decreased over the 27-month study.

Conclusions In this large sample, fall and injurious fall prevalence varied by nursing unit type in U.S. hospitals. Over the 27-month study, there was a small, but statistically significant, decrease in falls (P < 0.0001) and injurious falls (P < 0.0001).

From the *Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, Seattle, Washington; †Department of Epidemiology, Colleges of Medicine, and Public Health and Health Professions, University of Florida, Gainesville, Florida; ‡Institute on Development & Disability, Oregon Health and Science University, Portland, Oregon; §Department of Health Policy and Management, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas; ∥Faculty of Health Sciences, University of Southampton, United Kingdom; ¶Department of Preventive Medicine, University of Tennessee Health Science Center; **Department of Statistics, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida; ††School of Nursing, Vanderbilt University, Nashville, Tennessee; ‡‡Geriatric Research Education & Clinical Center (GRECC), Malcolm Randall VA Medical Center; and §§Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida.

Correspondence: Ronald I. Shorr, MD, MS, GRECC (182), Malcom Randall VAMC 1601 SW Archer Road Gainesville, FL 32608 (e-mail: rshorr@ufl.edu).

Disclosure: The authors disclose no conflict of interest.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any other institution or organization with which the authors are affiliated.

Grant Support: NIH/NIA R01-AG025285, NIH/NIA R01-AG033005

© 2013 Lippincott Williams & Wilkins, Inc.