1

In-Hospital Falls Increase Length of Stay

Tanya J. Dunne

Isabelle Gaboury

Maureen C. Ashe

2

Co-Authors

• Dr. Isabelle Gaboury– Department of Family Medicine, University of

Sherbrooke

• Dr. Maureen Ashe– Centre of Hip Health and Mobility– Department of Family Practice, University of

British Columbia

• Regional Lead for the VCH Regional Fall & Injury Prevention Program

Disclosure Statement

3

Background

• Acute inpatient falls lead to:– Injury– Functional decline– Prolonged hospitalization– Increased cost of care

• Few Canadian studies

• Fall Incident reporting system is not linked to Length of Stay information

4

ObjectivesPrimary:

– Determine the difference, if any, in acute care total LOS between patients who experienced an IHF compared with patients without an IHF matched by CMG, age, sex, and week of admission.

Secondary:– Identify the Case Mix Group codes

associated with highest number of IHFs

5

Methodology

• Retrospective observational study

• Conducted at Vancouver General Hospital, a 728-bed acute care teaching hospital

• Used administrative databases– Discharge Abstract Database &

Data Warehouse (DAD)– Patient Safety Learning System

6

Inclusion/Exclusion Criteria

• All patients 18 years and older admitted between November 1, 2009 & August 31, 2011 to VGH

• Included all admissions to all in-patient acute care hospital units/programs

• First admission with an IHF only used

• Excluded patients on maternity and paediatric wards.

7

Data Abstraction• Standard definition of a fall:

“unintentionally coming to rest on the ground, floor, or other lower level with or without an injury”

• Patient Safety Learning System (PSLS)– 1948 falls reported between

Nov 1, 2009 & Aug 31, 2011

used to pull DAD info– 1307 unique entries for patients with IHF after

manually compiling & cleaning data

8

Data Abstraction• Top 10 CMGs with the highest total

number of patients falling was generated from these 1307 entries

• List was used to extract DAD info for controls

• Resulted in 4206 unique

entries in the comparison

control group

9

• Propensity score matching

• Matched 292 patients with

306 controls by:– Case mix group (CMG)– Age– Sex– Week of admission

Statistical Analysis

10

Results

11

Results

• Average LOS for IHF cases was 37.2 days and 17.2 days for matched control patients.

• Average difference in LOS between patient groups was 20.1 days

12

Results

13

Results• Patients who did not have an IHF were 2.5

times more likely to be discharged earlier from acute care than patients who had an IHF

14

Conclusion

Falls occur more commonly in certain CMGs

• Within these CMGs experiencing a fall during an acute care hospitalization was associated with prolonged LOS.

15

• Cognitive impairment • Hip & femur procedures

• Stroke • Infections (pneumonia & UTI)

• Respiratory disease • Heart failure

• Palliative Care

• Identifying high-risk patients upon admission & implementing research-informed fall prevention interventions may:

» Reduce LOS » Reduce hospitalization costs» Reduce burden for patients &

families

Conclusion

16

Tanya Dunne

Regional Program Lead

Regional Fall & Injury Prevention Program

Vancouver Coastal Health

tanya.dunne@vch.ca

Contact

17