Consistent Differences in Medical Unit Fall Rates: Implications for Research and Practice

Objectives To determine the proportion of variation in long‐term fall rates attributable to variability between rather than within hospital units and to identify unit‐ and hospital‐level characteristics associated with persistently low‐ and high‐fall units. Design Retrospective study of administrative data on inpatient falls. Eighty low‐fall and 74 high‐fall units were identified based on monthly rankings of fall rates. Unit‐ and hospital‐level characteristics of these units were compared. Setting U.S. general hospitals participating in the National Database of Nursing Quality Indicators. Participants Nonsubspecialty medical units (n = 800) with 24 consecutive months of falls data. Measurements Monthly self‐reported unit fall rates (falls per 1,000 patient‐days). Results An estimated 87% of variation in 24‐month fall rates was due to between‐unit differences. With the exception of patient‐days, a proxy for unit bed size, low‐ and high‐fall units did not differ on nurse staffing or any other unit or hospital characteristic variable. Conclusion There are medical units with persistently low and persistently high fall rates. High‐fall units had higher patient volume, suggesting patient turnover as a variable for further study. Understanding additional factors underlying variability in long‐term fall rates could lead to sustainable interventions for reducing inpatient falls.