Risk-Adjusted Inpatient Falls as Indicators of Health System Performance During the COVID-19 Pandemic

Area of Science:

• Healthcare Management
• Patient Safety
• Epidemiology

Background:

• Inpatient falls are key patient safety indicators, but their behavior during health system stress is unclear.
• Understanding how safety indicators perform under prolonged disruption is crucial for healthcare resilience.
• This study examines inpatient fall indicators during a major system-wide stress event.

Purpose of the Study:

• To evaluate if risk-adjusted inpatient fall indicators can detect changes in hospital safety during system stress.
• To analyze the temporal relationship between system burden and fall outcomes.
• To assess hospital adaptation and safety performance during a prolonged disruption.

Main Methods:

• Retrospective time-series analysis of daily inpatient fall events and census data (Dec 2018–Mar 2023).
• Calculation of observed/expected (O/E) fall ratios using a pre-disruption prediction model.
• Regression analysis to link fall outcomes with hospital system burden indicators, controlling for seasonality.

Main Results:

• Observed and expected fall rates increased over time.
• Risk-adjusted O/E ratios declined in the later pandemic phase, indicating improved safety performance.
• Seasonal fall patterns were disrupted initially but re-emerged; system burden effects were strongest early on.

Conclusions:

• Risk-adjusted inpatient fall monitoring effectively captures dynamic hospital safety changes during system stress and adaptation.
• This indicator serves as a valuable tool for benchmarking safety surveillance beyond crisis periods.
• The findings highlight the utility of adaptive safety monitoring in healthcare systems.