Falls From the O.R. or Procedure Table

Area of Science:

• Anesthesiology
• Patient Safety
• Risk Management

Background:

• Patient falls before and after surgery receive significant attention.
• Falls from the operating room or procedure table during anesthesia are uncommon but potentially catastrophic.
• Limited published literature exists on intraoperative patient falls.

Observation:

• Two independent closed claims databases were queried for patient falls during anesthesia care.
• Data included provider, patient, and environmental conditions at the time of the event.
• 21 claims (1.2%) were identified from the American Society of Anesthesiologists Closed Claims Project; 0.07% from a private insurer.

Findings:

• Intraoperative falls occurred under general (71.5%), regional (19.5%), and monitored anesthesia care (9.5%).
• Both inpatients and outpatients undergoing diverse procedures are vulnerable.
• Common patient, provider, and environmental risk factors were identified.

Implications:

• Educating perioperative personnel on risk factors is crucial.
• Case reports and videos illustrate fall mechanisms and injuries.
• Strategies to mitigate risks and reduce liability costs are suggested.