Impact of level of nurse experience on falls in medical surgical units.

AIM: To describe nurse-specific and patient risk factors present at the time of a patient fall on medical surgical units within an academic public health care system. BACKGROUND: The incidence of falls can be devastating for hospitalized patients and their families. Few studies have investigated how patient and nurse-specific factors can decrease the occurrence of falls in hospitals. METHOD: In this retrospective cohort study, data were gathered on all patients who experienced a fall during January 2012 to December 2013. RESULTS: Falls were reduced dramatically when the number of nurses on the unit increased to five or six. Patient falls occurred most often when either the least experienced or most experienced nursing staff were providing care. CONCLUSION: Patient falls in hospitals can be influenced not only by patient-specific factors, but also by nurse staffing and experience level. IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study highlight factors which may contribute to hospital-based falls prevention initiatives and are amenable to nursing management decisions.

Risk Factors for Falls Among Hospitalized Acute Post-Ischemic Stroke Patients.

BACKGROUND: Falls remain an important benchmarking indicator for hospitals. Research identifies factors associated with falls among hospitalized patients in general. Similarly, the stroke literature outlines fall risk factors in the inpatient rehabilitation and community setting. PURPOSE: The aim of this study was to identify prevalence and risk factors for falls among acute, hospitalized AIS patients within an urban public healthcare system. Secondary aims were to identify activities present at the time of the fall and outcomes associated with falling. METHODS: This is a retrospective case-control study. Data were abstracted and merged from hospital stroke and fall registries and matched with medical records from 2013 to 2015 among all adult patients admitted for AIS. RESULTS: The study included 856 patients with AIS, with 2.3% experiencing a fall during the acute care hospitalization period. Falls among patients with AIS accounted for 1.4% of all hospitalized adult falls. Bivariate analysis indicate that a higher proportion of falls occurred among male patients when compared with female patients (75% male; χ = 3.964, P < .05) and among patients with a history of previous myocardial infarction or renal insufficiency (χ = 5.260, P < .05; χ = 11.116, P < .001, respectively). Multivariate analyses identify previous myocardial infarction (OR, 2.5; 95% confidence interval, 1.0-6.3; P = .04) and renal insufficiency (odds ratio, 4.2; 95% confidence interval, 1.5-12.2; P = .008) as strongest predictors of falls. The occurrence of a fall resulted in increased hospital length of stay (7.1 vs 4.0 days, P < .000) and slightly decreased functional outcome at discharge. Most falls occurred during the day shift while toileting, despite implementation and adherence to fall prevention programs. CONCLUSIONS: Fall rates among hospitalized patients with AIS are low, which may be reflective of increased vigilance among providers and widespread integration of fall prevention strategies. Consistent with the fall literature among other populations, the occurrence of a fall in the inpatient setting can substantially increase length of stay.

Characteristics and Predictors of Readmission to a Medical Short-Stay Unit.

Short-stay units are medical units with anticipated lengths of stay of 24-72 hours. The purpose of this study was to identify characteristics and predictors of 30-day readmission among patients admitted to a short-stay unit during two separate time periods. Findings suggest the presence of previous Emergency Department visits or hospitalizations should be considered when aligning discharge needs, as these may impact subsequent patient readmissions.