[In-hospital falls: a quality indicator?]

Falls have become increasingly focussed in the current discussion about patient safety and quality indicators because falls are one of the most frequently documented problems during geriatric treatment in hospital. We compared 811 "fallers" (total number of falls: 1177) and 5229 "non-fallers" in a geriatric hospital. The research question was: Are falls associated with an outcome of lower mobility (Barthel Index) at discharge?

A significant difference between the two groups was found in the following items: female (fallers 63.4% vs. non-fallers 69.8%), hospital stay (fallers 27.1 days vs. non-fallers 19.3 days), Barthel Index at admission (fallers 39.3 pts vs. non-fallers 48.3 pts). No linear relationship was found between the rate of falls and the mobility (Barthel Index at discharge). The lowest fall rates were found in the BI groups 80-100 pts (6.4%) and 0-20 pts (13.1%). A higher rate of falls was associated with a better outcome in two of the three mobility-related items of the Barthel Index (transfer, walk/wheelchair). 44% of the falls resulted in injuries or pain.

The comparison of fall rates requires risk adjustment. Falls are not a suitable quality indicator.