Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports
Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports
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DOI：
10.1136/qshc.2007.024695
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发表时间：
2008-12-01
影响因子：
--
通讯作者：
Glampson, B.
中科院分区：
文献类型：
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作者：
Healey, F.;Scobie, S.;Glampson, B.
导言：住院病人跌倒是很常见的，据报道，每1000个床日中有3到14人摔倒。它们造成身体和心理伤害，与康复受损、停留时间延长和费用过高有关，并导致投诉和诉讼，使其成为风险管理的关键领域。英格兰和威尔士患者安全事件的国家报告和学习系统(NRLS)被用于检查急诊护理、康复和精神健康专科医院的跌倒频率；相关伤害；跌倒的时间；患者的年龄和性别；并从中吸取一般性教训，为预防跌倒提供参考。方法：对NRLS数据库中2005年9月1日至2006年8月31日期间发生的滑倒、绊倒和跌倒进行回顾性搜索。如果组织至少每月返回报告，并且急性信托基金每月至少有100起患者安全事件，社区和心理健康信托基金每月至少有50起，则组织被归类为“定期报告”。跌跌率被标准化为每1000个占用床日的跌倒次数。报告的医院使用标准化的事故伤害程度类别，伤害率根据每次跌倒的严重程度计算。关键字搜索和自由文本检查相结合，以确定具体的伤害。还比较了一天中时间、性别和年龄的特定跌倒比率，并根据医院流行病学统计(HES)数据中的床位占有率调整了年龄和性别。大多数数据是描述性使用的，尽管95%的可信区间被用来促进组之间的比较，样本被概括到整个数据集。结果：总共收到了来自472个组织的206 350次跌倒报告。跌倒事件占所有报告的患者安全事件的32.3%。报告来自急诊医院152 069例(73.7%)，社区医院28 198例(13.7%)，精神病院26 083例(12.6%)。在这些机构中，只有102家可被归类为“定期报告”机构，在这些机构中，每1000个床位日的平均标准坠落率在急症医院为4.8，在精神病院为2.1，在社区医院为8.4。坠落致“无伤害”133 417次(64.7%)，“轻伤”144次(31.1%)，“中度伤害”7 506次(3.6%)，“重度伤害”1 230次(0.6%)，死亡26例。跌倒导致一定程度伤害的比例在护理环境中有显著差异：精神病院(44.5%；95%可信区间43.9至45.1)、社区医院(37.0%；95%可信区间36.4至37.6)和急诊医院(33.4%；95%可信区间33.2至33.7)。年龄85-的患者相对于卧床天数有比预期更高的跌倒可能性。男性为50.8%(95%CI为50.5~51.1)，女性为49.2%(95%CI为48.9~49.5)。(占用床位天数男性占45.5%，女性占54.4%。)跌倒的比例随时间变化很大，高峰出现在10：00至11：59之间。讨论：本文描述了对医院跌倒事件的最大规模的回顾研究，并利用了近500家不同类型机构的数据。它描述了不同类型的机构之间以及表面上相似病例组合的机构之间的跌倒记录和报告以及记录的跌倒比率的巨大差异。由于跌倒是报告的最常见的患者安全事故，迫切需要改进事故数据的地方报告、记录和重点分析，并在地方和国家一级更好地使用这些数据，以便更好地提供信息并针对跌倒预防，以及探索机构之间跌倒比率明显差异的原因。
Introduction: Falls in hospital inpatients are common, with reported rates ranging from 3 to 14 per 1000 bed days. They cause physical and psychological harm, are associated with impaired rehabilitation, increased length of stay and excess cost, and lead to complaints and litigation, making them a crucial area for risk management. A National Reporting and Learning System (NRLS) for patient safety incidents in England and Wales was utilised to examine frequency of falls in hospitals specialising in acute care, rehabilitation and mental health; related harm; timing; age and gender of patients who fell; and to draw general lessons from this which might inform fall-prevention strategies.Methods: The NRLS database was searched retrospectively for slips, trips and falls occurring between 1 September 2005 and 31 August 2006. Organisations were classified as "regularly reporting'' if they returned reports at least monthly and with at least 100 patient safety incidents per month for acute trusts and 50 per month for community and mental health trusts. Falls rates were standardised as number of falls per 1000 occupied bed days. Reporting hospitals used standardised categories for degree of harm from incidents, and injury rates were calculated as the percentage of injuries by severity per fall. Key word searches combined with free text scrutiny were conducted to identify specific injuries. Specific falls rates for time of day, gender and age were also compared, with age and gender adjusted for bed occupancy rates from Hospital Episode Statistics (HES) data. Most data were used descriptively, though 95% confidence intervals were used to facilitate comparisons between groups and where samples are generalised to the data set as a whole.Results: Reports of 206 350 falls were received from a total of 472 organisations. Falls incidents accounted for 32.3% of all reported patient safety incidents. 152 069 (73.7%) reports were from acute hospitals, 28 198 (13.7%) from community hospitals, and 26 083 (12.6%) from mental health units. Only 102 of these could be classified as "regularly reporting'' organisations, and in these the mean standardised rates of falls per 1000 bed days were 4.8 in acute hospitals, 2.1 in mental health units and 8.4 in community hospitals. 133 417 falls (64.7%) resulted in "no harm,'' 64 144 (31.1%) in "low harm,'' 7506 (3.6%) in "moderate harm,'' and 1230 (0.6%) in "severe harm,'' with 26 reported deaths. The proportions of falls resulting in some degree of harm varied significantly across the care settings: mental health units (44.5%; 95% CI 43.9 to 45.1), community hospitals (37.0%; 95% CI 36.4 to 37.6) and acute hospitals (33.4%; 95% CI 33.2 to 33.7). Patients aged 85-89 years had a higher-than-expected likelihood of falling relative to bed days. Males accounted for 50.8% (95% CI 50.5 to 51.1) of falls and females 49.2% (95% CI 48.9 to 49.5). ( Occupied bed days were 45.5% male and 54.4% female.) The proportion of falls varied considerably with time, with a peak occurring between 10: 00 and 11: 59.Discussion: This paper describes the largest retrospective study of hospital falls incidents and draws on data from almost 500 institutions of varying types. It describes wide variations in falls recording and reporting, and in recorded falls rates between institutions of different types and between institutions of ostensibly similar case-mix. As falls are the commonest reported patient safety incident, there is a pressing need for improvements in local reporting, recording and focused analysis of incident data, and for these data to be used at local and national level better to inform and target falls prevention, as well as to explore the reasons for large apparent differences in falls rates between institutions.