Inpatient Falls and Orthopaedic Injuries in Elderly Patients: A Retrospective Cohort Analysis From a Falls Register.

Background Hospital inpatient falls have been a major area of concern in the healthcare setting. This poses a multifaceted challenge to healthcare systems, as elderly patients are at increased risk of harm and significant morbidity secondary to inpatient falls. In addition, hospital admission increases the risk of falls in acutely unwell elderly patients. There remains little consensus on best practices in reducing inpatient falls. With this, lies the risk to life or quality of life to this cohort of patients. Moreover, it is not evident whether orthopaedic injuries sustained by elderly patients in hospital and their management, including rehabilitation, has evolved with time. Methodology This was a retrospective cohort analysis of all inpatient falls over a three-year period in a single UK District General Hospital. A total of 101,183 acute admissions were analysed. All falls were identified and categorised into harm categories according to National Patient Safety Alerts. Patients sustaining moderate harm or more were assessed to determine injuries sustained, patient-associated factors, factors surrounding the fall, management incurred, length of stay, and financial burden incurred. Results A total of 101,183 admissions were analysed revealing a total of 2,453 in-patient falls. The rate of inpatient falls was 2.42%. Of these, 49 (1.98%) patients sustained moderate harm or more. Patient-related factors included age and comorbidities; 82% of patients were above the age of 75, and 78% of patients had three or more medical comorbidities. Fall-related factors leading to moderate harm or more included time of fall and ward. Most falls occurred out of hours (80%) and in acute medical wards (69%). The average length of stay following fall was 2.4 weeks per patient and a combined 110 weeks in the three-year period. In non-deceased patients, increased dependency and reduced mobility at discharge were noted. The total hospital annual financial burden due to moderate harm or more following an inpatient fall was approximately £123,490.00. Length of stay was the major contributor to this (£90,090.00 annually). Conclusions Inpatient falls remain a considerable patient safety issue, with orthopaedic injuries playing a central role in harm to patients following these falls. These also pose considerable service and financial costs to healthcare organisations. Further work is needed to identify best practices in in-hospital fall prevention and streamlining post-fall management and rehabilitation.