Falls are a critical patient safety issue in psychiatric hospitals with an estimated 4 – 8 falls per 1,000 patient days, significantly higher than other healthcare settings.[1] Patients in psychiatric hospitals face unique challenges that increase fall risk:
- Medication side effects: many psychotropic drugs cause dizziness, low blood pressure, or lowered alertness.
- Cognitive and behavioral factors: psychiatric conditions may impair cognitive functions, such as increased anxiety resulting in decreased attention.
- Self-care: severe psychiatric conditions impact self-care with ensuing malnutrition or muscle atrophy.
- Mobility: Unlike other hospital settings, psychiatric inpatients are encouraged to move independently through daily activities and a treatment schedule.
We analyzed over 46,000 patient fall incidents in nearly 200 facilities over the past six years.
Staff are a key component of falls
- About 35% of falls were observed by staff and 33% were discovered by staff after the patient was found on the floor.
- 31% were reported by the patient themselves or through other means.
Most falls happen early in the patient’s stay
- Day 2 (the day after admission) had the highest fall rate, suggesting the initial adjustment period is particularly risky.
- The median length of stay for patients who fell was 11 days, yet the majority of falls occurred within the first 3-5 days.
These trends hold true regardless of total hospitalization time, indicating early intervention at admission could significantly reduce falls.
Patients are only slightly more likely to fall in communal vs private locations
- Roughly 55% of falls occur in common areas (e.g., hallways, cafeteria, or gym) and are more likely to be observed by staff.
- Roughly 45% of falls occur in the patient’s room or bathroom and are less likely to be observed by staff.
This distribution highlights the need for balanced fall prevention strategies in both private and high-traffic spaces.
Patients fall at all hours, but some hours have higher rates
Fig 1. (Interactive) Number of Falls by Time of Day and Location
While patient and treatment related factors are critical, environment and time-related factors also influence fall risk.
- Peak risk occurs from 4 PM to 9 PM, showing a spike compared to other daytime hours.
- Falls are least frequent between midnight and 5 AM (16% of falls), with higher rates during daytime and evening hours.
- Fall locations vary by time. Nighttime falls predominantly occur in private areas (e.g., bedrooms and bathrooms), while daytime/evening falls occur most often in communal spaces (e.g., hallways and common rooms).
Patients over age 50 are more likely to fall, and more likely to fall in their rooms
- While the total number of falls is higher among younger patients, there are overall fewer geriatric inpatients. Indeed, the fall rate per 1,000 patient days is greater among geriatric inpatients units (rate ranged 3-19), than adult inpatients units (rate ranged 0.4-8).
- Patients over age 50 were more likely to fall in their rooms, where 33-36% of falls occurred for age groups of 50+ compared to only 24% among patients under 50.
What can facilities do?
Most facilities would benefit from adopting validated tools designed to estimate individual patient fall risk and having protocols for at risk patients. Further, facilities committed to minimizing fall risk should explore the use of heat maps to identify their aggregate falls pattern. Heat maps help to highlight a facility’s unique environmental and timing factors impacting their falls and allow for targeted prevention strategies for example, a given facility may need to increase staff vigilance in common areas during high-risk hours (5PM – midnight) and enhance nighttime checks in private areas for patients with sleeping problems. Other facilities may need to focus on medication timing or environmental changes such as increased lighting or reduced clutter in high risk zones.
References:
[1] Carpels A, de Smet L, Desplenter S, de Hert M. Falls among psychiatric inpatients: A systematic review of literature. Alpha Psychiatry. 2022;23(5):217-222.
