Falls in an Australian Hospital During the COVID-19 Pandemic: A Study of Patient Safety Incident Reports

Inpatient falls pose a significant challenge in hospitals, impacting patient safety and resources. This retrospective study aimed to analyze the impact of the COVID-19 pandemic on fall incidents in a major metropolitan tertiary referral and teaching hospital in New South Wales (NSW), Australia.

Utilizing clinical informatics, data from Clinical Health Information Exchange (CHIE) database, electronic medical records (eMR), and the NSW Health Incident Information Management System (IIMS)/Incident Management System Plus (IMS+) were collected. Inpatient falls reported at the study hospital between July and December 2019, 2020, and 2021 for patients aged 18 years and above were included. Extracted data encompassed patient demographics, medical history, fall characteristics, contributing factors, and fall incident harm scores. Descriptive and inferential statistics were undertaken using SPSS V 25, and inductive content analysis was used to analyze the narratives relating to the contributing factors for falls.

A total of 1399 inpatient falls were reported during the study period. Falls per 1000 occupied bed days (OBD) varied: 3.83 in 2019, 3.41 in 2020, and 4.35 in 2021. A significant increase in fall incidents was observed in 2021 compared to 2020. Most falls occurred on a weekday, particularly between 1400 and 2159 hours. Medicine departments reported the highest number of falls, followed by aged care units. Incident harm scores at level 3, indicating moderate injury, were prevalent across all 3 years. Contributing factors to falls according to the IIMS/IMS+ criteria were diverse, with "Patient complexity/acuity," "Patient engagement and compliance," "Hazard/unsafe," and "Clinical risk screening/assessment" emerging prominently. In addition, 7 distinct themes contributing to inpatient falls were identified through inductive analysis.

The study highlighted increased inpatient falls (4.35 falls per 1000 OBDs) during the July to December 2021 study period. Understanding fall patterns is vital for improving safety protocols. Emphasising incident reporting, staff training, environmental adjustments, and mobility-related risk management is crucial to reducing inpatient falls and fall-related injury during restricted visitor access during pandemics.