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Estimating the Cost of Serious Injurious Falls in a Canadian Acute Care Hospital

Published online by Cambridge University Press:  24 May 2012

Aleksandra A. Zecevic ,
Bert M. Chesworth ,
Gregory S. Zaric ,
Qing Huang ,
Anneke Salmon ,
Deb McAuslan ,
Randy Welch  and
Douglas Brunton
Aleksandra A. Zecevic*
Affiliation:
School of Health Studies, Western University
Bert M. Chesworth
Affiliation:
School of Physical Therapy, Western University
Gregory S. Zaric
Affiliation:
Ivey School of Business, Western University
Qing Huang
Affiliation:
Department of Epidemiology and Biostatistics, Western University
Anneke Salmon
Affiliation:
School of Health Studies, Western University
Deb McAuslan
Affiliation:
Nursing Practice Consultant
Randy Welch
Affiliation:
Case Costing Analyst
Douglas Brunton
Affiliation:
Risk Management Specialist
*
*Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Aleksandra A. Zecevic, Ph.D. Western University School of Health Studies Arthur and Sonia Labatt Health Sciences Bldg., Room 220 London, ON, N6A 5B9, Canada (azecevi2@uwo.ca)
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Abstract

Falls represent 40 per cent of hospital accidents, and consequences range from none to serious injuries. The purpose of this study was to estimate the average hospital cost and length of stay (LOS) associated with serious injurious falls in an acute care hospital. We used data from risk management and case costing databases to identify cost associated with a serious injury after an in-hospital fall. Thirty-seven injured patients were matched with 2,113 controls by the most responsible medical diagnosis, age, and gender. Cost and LOS were compared using t-tests and multivariate regression. Average costs for seriously injured fallers and non-faller controls were CAD$44,203 and CAD$13,507, while LOS was 45 and 11 days respectively. Hospital cost for a seriously injured faller was $30,696 (95% CI: $25,158 – $36,781) greater than the cost for a non-faller. Hospital managers have a leading role in creating system-wide falls prevention programs and reducing hospital costs.

Résumé

Les chutes représentent 40 pour cent des accidents d’hôpitaux et leurs conséquences vont de zéro à des blessures graves. Le but de cette étude a été d’estimer le coût moyen à l’hôpital de la durée du séjour (DS) associée aux chutes liées aux préjudices graves dans un hôpital de soins actifs. Nous avons utilisé les données de gestion des risques et des bases de données qui représentent les frais associés à une blessure grave après une chute à l’hôpital. On a comparé trente-sept patients blessés à 2,330 contrôles en utilisant le diagnostic le plus responsable médical, et par l’âge et par le sexe des patients. En utilisant les t-tests et la regréssion multivariée, on a comparé le coût et la DS. Les coûts moyens pour ceux qui se sont grièvement blessés en tombant, et pour les contrôles sans chutes, étaient DC 44,203 $ et DC 13,507 $ tandis ceux de la DS était, respectivement, 45 et 11 jours. Le coût des soins d’hospitalisation pour un patient qui a subi une chute résultante en blessures graves était 30,696 $ (95% IC : $25,158 – $36,781) supérieur au coût pour quelqu’un qui ne s’est pas tombé. Les gestionnaires d’hôpitaux jouent un rôle de premier plan en créant des programmes dans le réseau pour prévenir les chutes et réduire les coûts hospitaliers.

Keywords

coût de chuteprévention des chuteshôpitalblessure gravecoûts de cascost of fallfalls preventionhospitalserious injurycase costing
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 31 , Issue 2 , June 2012 , pp. 139 - 147
Copyright
Copyright © Canadian Association on Gerontology 2012

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References

Bates, D.W., Pruess, K., Souney, P., & Platt, R. (1995). Serious falls in hospitalized patients: Correlates and resource utilization. The American Journal of Medicine, 99, 137–143.Google Scholar
Canadian Institute for Health Information (CIHI). (2002). Hospital costs of trauma admissions in Ontario, 1999/2000. Toronto, Ontario, Canada: Ontario Trauma Registry.Google Scholar
Canadian Institute for Health Information (CIHI). (2004). Ontario Trauma Registry 2004 Report - Injury Hospitalizations (includes 2002-2003 data). Ottawa, Ontario, Canada: Canadian Institute for Health Information.Google Scholar
Carroll, N.V., Slattum, P.W., & Cox, F.M. (2005). The cost of falls among the community-dwelling elderly. Journal of Managed Care Pharmacy, 11, 307–316.Google Scholar
Charlson, M.E., Charlson, R.E., Peterson, J.C., Marinopoulos, S.S., Briggs, W.M., & Hollenberg, J.P. (2008). The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. Journal of Clinical Epidemiology, 61, 1234–1240.Google Scholar
Charlson, M.E., Pompei, P., Ales, K.L., & MacKensie, C.R. (1987). A new method of classifying prognostic comorbidity in longitudinal populations: Development and validation. Journal of Chronic Diseases, 40, 373–383.Google Scholar
Evans, D., Hodgkinson, B., Lambert, L., & Wood, J. (2001). Falls risk factors in the hospital setting: A systematic review. International Journal of Nursing Practice, 7, 38–45.Google Scholar
Fixen, D., Blasé, K., Duda, M., Metz, A., Naoom, S., & van Dyke, M. (2010). Implementing evidence based practices: Are we falling down on the job? National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill. Presentation at the Canadian Fall Prevention Conference 2010, Vancouver, BC. Retrieved May 2, 2012, fromhttp://www.fpg.unc.edu/∼nirn/resources/presentations/FallsConference_03-2010.pdf.Google Scholar
Goodwin, M.B., & Westbrook, J.I. (1993). An analysis of patient accidents in hospital. Australian Clinical Review, 13, 141–149.Google Scholar
Groves, J.E., Lavori, P.W., & Rosenbaum, J.F. (1993). Accidental injuries in hospitalized patients. A prospective cohort study. International Journal of Technology Assessment in Health Care, 9, 139–144.Google Scholar
Halfon, P., Eggli, Y., Van Melle, G.V., & Vagnair, A. (2001). Risk of falls for hospitalized patients: A predictive model based on routinely available data. Journal of Clinical Epidemiology, 54, 1258–1266.Google Scholar
Halligan, M., & Zecevic, A. (2011). Safety culture in healthcare: A review of concepts, indicators, measures and progress. BMJ Quality and Safety in Health Care, 20(4), 338–343.Google Scholar
Heinrich, S., Rapp, K., Rissmann, U., Becker, C., & Koenig, H. (2010). Cost of falls in old age: A systematic review. Osteoporosis International, 21(6), 891–902.Google Scholar
Hendrich, A., Nyhuis, A., Kippenbrock, T., & Soja, M. (1995). Hospital falls: Development of a predictive model for clinical practice. Applied Nursing Research, 8, 129–139.Google Scholar
Herman, M., Gallagher, E., & Scott, V. (2006). The Evolution of Seniors’ Falls Prevention in British Columbia: Working strategically and collectively to reduce the burden and impact of falls and fall-related injury among seniors. Victoria, British Columbia, Canada: Ministry of Health.Google Scholar
Hitcho, E.B., Krauss, M.J., Birge, S., Dunagan, W.C., Fischer, I., Johnson, S., et al. . (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. Journal of General Internal Medicine, 19, 732–739.Google Scholar
Krauss, M.J., Evanoff, B., Hitcho, E., Ngugi, K.E., Dunagan, W.C., Fischer, I., et al. . (2005). A case-control study of patient, medication, and care-related risk factors for inpatient falls. Journal of General Internal Medicine, 20, 116–122.Google Scholar
Nadkarni, J.B., Iyengar, K.P., Dussa, C., Watve, S., & Vishwanath, K. (2005). Orthopaedic injuries following falls by hospital in-patients. Gerontology, 51, 329–333.Google Scholar
Oliver, D., Daly, F., Martin, F.C., & McMurdo, M.E. (2004). Risk factors and risk assessment tools for falls in hospital in-patients: A systemic review. Age and Ageing, 33, 122–130.Google Scholar
Ontario Case Costing Initiative. (2009). Retrieved November 19, 2009, fromhttp://www.occp.com.Google Scholar
Quan, H., Sandararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.C., et al. . (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 43, 1130–1139.Google Scholar
Schwendimann, R., Buhler, H., De Geest, S., & Milisen, K. (2006). Falls and consequent injuries in hospitalized patients: Effects of an interdisciplinary falls prevention program. BMC Health Services Research, 6, 69–77.Google Scholar
Scott, V., Wagar, B., Sum, A., Metcalfe, S., & Wagar, L. (2010). A public health approach to fall prevention among older persons in Canada. Clinics in Geriatric Medicine, 26(4), 705–718.CrossRefGoogle ScholarPubMed
SMARTRISK. (2009). The Economic Burden of Injury in Canada. Toronto, Ontario, Canada: SMARTRISK.Google Scholar
Sorensen, S., de Lissovoy, G., Kunaprayoon, D., Resnick, B., Rupnow, F., & Studenski, S. (2006). A taxonomy and economic consequences of nursing home falls. Drugs & Aging, 23, 251–262.Google Scholar
Teasell, R., McRae, M., Foley, N., & Bhardwaj, A. (2002). The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk. Archives of Physical Medicine and Rehabilitation, 83, 329–333.Google Scholar
Tinetti, M.E. (2003). Preventing falls in elderly persons. The New England Journal of Medicine, 348, 42–49.CrossRefGoogle ScholarPubMed
Titler, M., Dochterman, J., Picone, D.M., Everett, L., Xie, X.J., Kanak, M., et al. . (2005). Cost of hospital care for elderly at risk of falling. Nursing Economics, 23, 290–306.Google Scholar
von Renteln-Kruse, W., & Krause, T. (2004). Fall events in geriatric hospital in-patients. Results of prospective recording over a 3 year period. Zeitschrift fur Gerontologie und Geriatrie, 37, 9–14.Google Scholar
World Health Organization (WHO). (2009). International classification of diseases (ICD) (2009). Retrieved November 7, 2009, fromhttp://apps.who.int/classifications/apps/icd/icd10online/.Google Scholar
Zecevic, A., Salmoni, A., Lewko, J.H., & Vandervoort, A.A. (2007). Seniors Falls Investigative Methodology (SFIM): A systems approach to the study of falls in seniors. Canadian Journal on Aging, 26, 281–290.Google Scholar
Zecevic, A., Salmoni, A., Speechley, M., & Vandervoort, A.A. (2006). Defining a fall and reasons for falling: Comparison among the views of seniors, health care providers, and the research literature. The Gerontologist, 46(3), 367–376.Google Scholar