Falls thus generate a high amount of additional costs, as shown for example by data from the UK. For inpatients in acute care hospitals falls are one of the most frequently reported safety accidents. A fall is defined as “any unintentional change in position that results in the client coming to rest on the ground or other lower level, regardless of the reason”. Inpatient falls in hospitals and subsequent injuries are a widely recognized and highly relevant health problem associated with lower quality of life, longer hospital stays and higher healthcare costs. Patient-related fall risk factors such as care dependency, history of falls and cognitive impairment should be routinely assessed. Risk adjustment of inpatient fall rates could reduce misclassification of hospital performance and enables a fairer basis for decision-making and quality improvement measures. After risk adjustment, 2 low-performing hospitals remained. Unadjusted caterpillar plots identified 20 low- and 3 high-performing hospitals. Female sex ( OR 0.78, CI 0.70–0.88) and postoperative patients ( OR 0.83, CI 0.73–0.95) were associated with a lower risk of falling. With odds ratios between 1.26 and 0.67, eight further ICD-10 diagnosis groups were included. Risk adjustment showed that the following factors were associated with a higher risk of falling: increasing care dependency (to a great extent care dependent, odds ratio 3.43, 95% confidence interval 2.78–4.23), a fall in the last 12 months ( OR 2.14, CI 1.89–2.42), the intake of sedative and or psychotropic medications ( OR 1.74, CI 1.54–1.98), mental and behavioural disorders ( OR 1.55, CI 1.36–1.77) and higher age ( OR 1.01, CI 1.01–1.02). One hundred thirty eight hospitals and 35,998 patients were included in the analysis. Two-level logistic regression models were used to construct unadjusted and risk-adjusted caterpillar plots to compare inter-hospital variability in inpatient fall rates. After excluding maternity and outpatient wards, all inpatients older than 18 years were included. Methodsĭata on inpatient falls in Swiss acute care hospitals were collected on one day in 2017, 20, as part of an annual multicentre cross-sectional survey. Therefore, the aims of this study were to develop an inpatient fall risk adjustment model based on patient-related fall risk factors, and to analyse the impact of applying this model on comparisons of inpatient fall rates in acute care hospitals in Switzerland. Research on risk-adjusted fall rates and their impact on hospital comparisons is currently sparse. Thereafter, the remaining variability in risk-adjusted fall rates can be attributed to differences in quality of care provided by a hospital. To improve the comparability of performance between hospitals, adjustments for patient-related fall risk factors that are not modifiable by care are recommended. Comparing inpatient fall rates can serve as a benchmark for quality improvement.
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