Hospitalized patients continue to suffer from falls despite the use of criteria to identify the highest-risk admissions, according to a study published in this month's Journal of Hospital Medicine.
The report, "Predictors of Serious Injury Among Hospitalized Patients Evaluated for Falls" (JHM. 2010;5:63-68), is a retrospective study of inpatients at 13 medical and surgical units at Mount Sinai Medical Center in New York City. A total of 513 patients experienced 636 falls during that timeframe, according to the study. The incidence rate of falls was 1.97 per 1,000 patient days. Evidence of trauma after a fall (odds ratio=24.6, P<0.001) and ambulatory status (OR=7.3, P<0.01) were found to be "independent predictors of injury being found on imaging studies."
Sara Bradley, MD, associate medical director at the Martha Stewart Center for Living, assistant professor at the Brookdale Department of Geriatrics, and assistant professor at the palliative-care department at Mount Sinai School of Medicine, says the study is the first step in trying to reduce the rate of falls. She says hospitalists are in prime position to trumpet the issue as a QI initiative, particularly as federal funding sources pull back from reimbursement for such preventable errors as falls.
"It's multifactorial, but the doctors, in many ways, are leading this charge," Dr. Bradley says. "If they think it's important and they're leading the nurses and the physical therapists and the family in seeing this as important, that's how it happens."
At Mount Sinai, a pilot program launched last fall implemented a checklist to further the identification of high-risk patients. Risk factors include cognitive status, environment, mobility, hydration, and nutrition. Future risks that may be added to the checklist include medication.
"None of this high-tech," Dr. Bradley acknowledges. "It's all about little interventions, but each of those interventions adds up."