Hospital Falls: retrospective analysis of risk factors and prevention strategies in a healthcare organization in northern Italy.

Abstract

Background: Hospital falls represent a critical patient safety issue, despite being potentially preventable events. Effective management is carried out through clinical risk assessment and requires a thorough evaluation of risk factors, incident reporting, and the implementation of targeted interventions. This study focuses on analyzing falls in a healthcare organization in Northern Italy during the period 2020-2022, examining variables such as risk factors, fall locations, and clinical and organizational consequences.

Objective: To quantify and analyze hospital falls within the examined healthcare organization, stratifying by age, gender, operational unit, fall location, intrinsic and extrinsic factors, and assessing the impact on patients in terms of diagnostic tests, reported injuries, and management of incident reporting forms. Additionally, the study aims to evaluate existing organizational proposals for fall management adopted by the healthcare organization.

Materials and methods: A retrospective, multicenter study conducted across five hospitals in a healthcare organization in Northern Italy, based on incident reporting data from 2020 to 2022. Statistical analysis includes the Kruskal-Wallis test, Dunn's test, Fisher's exact test, and the Chi-square test for continuous and categorical variables.

Results: In a study of 1,032 incident reporting cases in a hospital, most falls (0.85% of the total) occurred primarily in hospital rooms (64.2%). The most common extrinsic factors included inappropriate footwear (17%). The medical area (58.33%) was the most affected by falls. Among intrinsic factors, 28% of cases showed cognitive deficits, while 13% had urinary and fecal urgency. Significant injuries were reported in 26% of patients, including contusions and fractures, with 23 sentinel events. Comparing the five hospitals (Hospital 1, Hospital 2, Hospital 3, Hospital 4, Hospital 5), falls were most frequent in hospital rooms (67.18%), with the most common extrinsic factors including inappropriate footwear (up to 26.3%). Significant intrinsic factors included cognitive deficits (up to 40%) and urinary/fecal urgency (up to 13.1%). Patient injuries were reported in approximately 28% of cases, with various hospitals highlighting specific issues such as incomplete incident reporting forms.

Discussion: Hospital falls are influenced by multiple factors, including physical environments and patients' clinical conditions. Educational interventions and procedural reviews have contributed to improved risk management. It is essential to promote a hospital safety culture through integrated strategies addressing both human and organizational factors.

Conclusions: Effective management of falls in hospitals within the Northern Italy healthcare organization requires multidimensional approaches and targeted interventions based on evidence. Implementing initiatives such as staff training and procedural revisions is crucial to improving patient safety and optimizing healthcare services.