Falls Incidents

Each year nearly one quarter of people over 60 years of age will experience a fall. For some people, the injuries caused by their fall may be so serious that they can no longer live independently.

Falls account for over 80 per cent of all injury-related hospital admissions for people aged 65 years and older. They can occur at any age, but the frequency and severity of falls-related injuries increases significantly with age and frailty.

Falls are one of the most frequently reported clinical incidents in hospitals worldwide and are associated with increased:

  • length of hospital stay
  • care and use of health resources
  • discharge rates to a nursing home or residential care facility.

Measuring falls incidents

The World Health Organization (WHO) defines a fall as an event which results in a person coming to rest accidentally on the ground, floor or other lower level. This definition covers all types of falls-related clinical incidents, including:

  • near-misses
  • intercepted falls where the patient is lowered to the ground
  • suspected/unwitnessed slips/trips/falls
  • witnessed slips/trips/falls.

Falls are measured as a rate of falls using the number of falls-related clinical incidents divided by the number of beds occupied by patients each day (occupied bed days).

Fall rates of 4–12 per 1,000 bed days during healthcare have been described in patients 65 years and older.

In certain hospital settings, such as rehabilitation, more than 40 per cent of patients with specific clinical problems experience 1 or more falls during their admission. Of these falls, 30 per cent result in injuries.

As there is currently no national or state agreed falls rate benchmark, EMHS sites and services use the Australian Council for Healthcare Standards (ACHS) annual peer rate as the benchmark. The ACHS annual peer rate provides a comparison based on a yearly average across all Australia/New Zealand organisations participating in the ACHS Clinical Indicator Program. The most recently published ACHS annual peer rate has applied since 2015 and equates to ≤3.5 falls per 1,000 occupied bed days.

To prevent falls and to work towards zero harm from falls, EMHS patients are assessed for the risk of a fall and the potential to be harmed from falls:

  • on presentation to hospital
  • during their admission
  • when clinically indicated.

A combination of falls prevention and harm minimisation strategies are then used for those patients assessed as at risk of falling. These strategies form a falls prevention plan for the patient, and this is monitored regularly to ensure its effectiveness and appropriateness.

Patients and carers are also informed of the identified risks from falls and are encouraged to participate in the development of their falls prevention plan.

When a EMHS hospital’s falls rate does not meet the agreed benchmark a review is undertaken and an action plan is developed to address the issue/s.

How do we measure up

The graph below shows the combined rate of reported falls incidents for the EMHS hospitals:

  • Armadale Health Service
  • Kalamunda Hospital
  • Bentley Hospital
  • Royal Perth Hospital

Chart: Rate of reported fall incidents and falls with harm per 1,000 occupied bed days.

Graph: rate of falls / falls with harm per 1,000 OBD

What the figures mean

EMHS fosters a culture that encourages the reporting of clinical incidents to drive quality improvement.

The graph shows the rate of reported fall incidents and falls with harm per 1,000 occupied bed days by year in EMHS hospitals.

A lower rate of falls with harm is desirable.

The green columns show that the overall rate of reported falls for EMHS from July 2018 to June 2019 was 4.0 falls per 1,000 occupied bed days, which slightly higher than the benchmark rate of ≤ 3.5. However, less than one fifth of the reported falls resulted in any harm to the patient, and the rate of falls resulting in harm has decreased from 1.6 per 1,000 bed days in 2015/16 to 1.2 2018/19.

EMHS encourages the reporting of falls and the overall result is indicative of this. The decreasing rate of harm resulting from these incidents shows that strategies to reduce harm from falls are being effective: harm was prevented in more than half of the falls/near miss incidents reported.

EMHS constantly strives to reduce the rate of falls incidents across all EMHS hospitals and preventative strategies continue to be put in place.

Last Updated: 28/08/2019