Factors Associated With Inpatient Injurious Falls in Acute Care Hospitals

Background: Inpatient falls and injurious falls in acute care settings have significant impact on patients. Despite the implementation of several federal initiatives in preventing falls and injurious falls, inpatient falls and injurious falls still are prevalent in the United States. Inpatient falls and injurious falls are a complicated phenomenon and can be contributed to multilevel factors including organization at the hospital and unit levels, nursing care process, and patient-specific factors. However, gaps exist in the literature on the associations of injurious falls with multilevel factors. The purpose of this study is to examine the associations of injurious falls among all patient falls with multilevel factors in acute care hospitals.

Methods: Guided by the modified Donabedian Structure–Process–Outcome (SPO) model, this cross-sectional, correlational study used National Database of Nursing Quality Indicators^® (NDNQI^®) data from July 2013 to June 2014. The sample included all falls recorded in adult medical, surgical, medical-surgical, and step-down units (N = 2,299) in NDNQI^® participating hospitals (N = 488). The STATA (Version 14) was used to conduct descriptive and hierarchical negative binominal regression analyses to examine the significance of association of injurious falls with multilevel factors including organizational structure (i.e., hospital size, teaching status, and Magnet^®  status), unit structure (i.e., nurse staffing and unit type), nursing care process (i.e., falls without employee assistance, fall risk assessment, implementation of fall prevention protocol, and physical restrain use) and unit patient population factors for patients who fell (i.e., gender, and fall risk status). The outcome variable was the number of injurious falls among all recorded falls.

Results: There were on average 78.9 reported annual falls (range = 1 - 864) and 5.2 injurious falls (range = 1-131) across the units. Falls in teaching hospitals were 13% less likely to be injurious falls (p = 0.001). Falls on surgical units were 8% more likely to be injurious falls (p = 0.021). RN hours per patient day (HPPD) demonstrated a non-linear relationship with injurious falls. Falls without employee assistance were 50% more likely to be injurious falls (p = 0.004).

Conclusions/Implications: The study adds new knowledge about multi-level factors contributing to inpatient injurious falls in acute care hospitals. Nurse leaders, researchers and policy makers may develop, implement and improve fall prevention programs based on the identified risk factors. The study also provides important implications for future research on injurious fall prevention in acute care hospitals.