Table 38 'Patient Falls'

PSI 37: Patient Falls
Review of an OECD PSI (33).
Dimension Description
Description of Specific
Aspects of Patient Safety
Falls are a common cause of morbidity and mortality especially among
elderly in-patients over 65 years of age. Falls are associated with
functional disability and injury, increased length of stay, and risk of
nursing home placement from hospital. Often falls are the result of the
interaction of many factors. Falls may be caused by the persons’ health
status, response to medical interventions, external factors such as the
type of floor or other factors. Thus in-hospital fall is an adequate
measure of patient safety.
Aim of the PSI This PSI is intended to flag cases of in-hospital patient falls resulting
in death or major permanent loss of function.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) JCAHO sentinel events (33).
Extent of Clinically
Testing
The OECD Health Care Quality Indicators (HCQI) Project was
initiated to implement quality measures for international
benchmarking of medical care at the health system level. Five priority
areas including patient safety were selected. International expert
panels were formed to identify clinically important, scientifically
sound, and feasible measures based on a structured consensus process.
The consensus process was successfully completed in all five priority
areas leading to a recommendation of 86 indicators of which 21 cover
patient safety (33).
The OECD panel reviewed the literature and found that studies show
that intervention can decrease the risk of falls but also evidence that
interventions to reduce specific risk factors resulted in a 30% reduction
in falls over one year in a prospective community cohort (33).
Evidence of Clinically use
of Standards
No evidence of clinically use of standards was found.
PSI category Theme Related PSI: “In-Hospital Fall”.
Data definitions Cases of in-hospital fall with serous consequences per 1000
admissions.
Numerator Description Number of patient falls
that result in death or major permanent loss of
function as a result of the injuries sustained in the fall direct. A fall is
defined as unintentionally coming to rest on the ground, floor, or other
lower level, but not as a result of syncope or overwhelming external
force.
Denominator Description All hospital admissions.
SImPatIE WP4 – Catalogue of Patients Safety Indicators
96
Data Source Administrative data.
Identifying the
institutional context
The impact of falls makes this PSI important for both financial and
quality improvement policies.
Care Setting The PSI applies for high quality care.
Professionals Responsible
for Health Care
All health care workers.
Lowest Level of Health
Care Delivery Addressed
Individual clinical department.
Allowance for Patient
Factors
No risk adjustment described.
Stratification by
Vulnerable Populations
No stratification.
Standard of Comparison No specific standards given.
Scoring Not specified