References - Patient Falls
References are listed alphabetically.
Australian Commission on Safety & Quality in Healthcare (ACSQHC)
Australian non-acute private hospitals
The benchmark rate for rehabilitation hospitals is taken from the Australian Council on Healthcare Standards Clinical Indicators Program, Hospital-wide clinical indicator 4.1 “Inpatient Falls”. For general acute hospitals, the benchmark rate is the general aggregate rate, Australia wide. For rehabilitation hospitals however, falls can be more likely as the patients are encouraged to mobilise as part of their therapy. The more appropriate peer group is peer group D2/E5 - Sub-acute and non-acute hospitals. The benchmark rate used is from the most recent 6 month period reported.
The Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program is a data repository, analysis and reporting service provided to healthcare organisations. It provides comparative information on the processes and outcomes of health care. Participating organisations submit indicator data for inclusion in an extensive indicator database. Data are aggregated and analysed twice yearly and results are provided in the form of comparative reports. These reports compare results across all contributing organisations as well as providing a comparison with 'peer’ organisations based on a number of variables.
According to the World Health Organization (WHO), a fall is defined as being ‘‘an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.’’ World Health Organisation. Definition of a Fall [on-line]. Available 3/8/2011 at:
How we work out our falls rate
Falls rate is taken from ACHS Clinical Indicator, Hospital-Wide 4.1 Inpatient Falls. Benchmark rate taken from general aggregate rate for the most recent half-year reported.
In previous versions of MyHealthscope, falls rates included day patient falls as well as day patient beddays. As of June 2014, day patients continue to be included in the number of falls and are excluded from the beddays.
Limitations of data
Comparing fall rates between different hospitals can be helpful, but there are some limitations to the data. Using a falls rate as a percentage of patient days helps us compare our performance, but other difficulties may include:
- Different hospitals may define a “fall” in different ways; some include "near misses or near falls" while others stick strictly to the WHO definition.
- Staff may not report or document all falls that occur. Alternatively, sometimes a patient tells a staff member that they have fallen, but no one has witnessed this. This may result in some under or over reporting of fall rates.
- Some organisations only collect data on first falls, but not subsequent falls. This can result in lower fall rates.
- Hospitals admit different types of patients and the rate of falls can differ depending on whether the patient is admitted (for example) for surgery, mental health treatment, intensive care or rehabilitation. This can lead to different falls rates.
According to Janice Morse (2009) Preventing Patient Falls - Falls rates vary according to the patient care setting. They are lowest in general, acute care hospitals and highest in nursing homes, with the rates in the rehabilitation hospital falling somewhere in between.
Morse, J. (2009). Preventing Patient Falls: Establishing a Fall Intervention Program. Springer Publishing Company, New York. Available from:
Note on the Benchmark Rate
The international literature is scanned for recent developments in falls rates:
- Victorian Quality Council (2006). Evaluation of the effectiveness of the "Minimising risk of falls and fall-related injuries guidelines for acute, subacute and residential care settings". Falls rates vary between 2 and 7 per 1000 bed days (0.2 to 0.7%) in acute settings.
- National Database of Nursing Quality Indicators (NDNQI) in the USA. Falls - approx. 3.6 per 1000 bed days (0.36%)
- Institute for Clinical Systems Improvement (ICSI). Prevention of falls (acute care). Health care protocol. Bloomington (MN): 2010 Apr. In 2007, Massachusetts publicly reported average rates of 3.57 falls/1,000 patient days in hospitals of 200-299 beds, and 4.76 falls/1,000 patient days in hospitals over 500 beds.
- Agency for Healthcare Research & Quality: http://www.qualitymeasures.ahrq.gov/content.aspx?id=27679