# Adult Inpatient Hospital Falls with Injury: A Retrospective Analysis

Lemon Bacalso, Ibrahim Alzamil, Naeema Houri, Maria Aldossari

► To cite this version:

Lemon Bacalso, Ibrahim Alzamil, Naeema Houri, Maria Aldossari. Adult Inpatient Hospital Falls with Injury: A Retrospective Analysis. asian journal of research in nursing and health, 2023, 6 (1), pp.239-248. hal-05119612

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# Adult Inpatient Hospital Falls with Injury: A Retrospective Analysis

Lemon Albores Bacalso<sup>a++*</sup>, Ibrahim Alzamil<sup>a++</sup>, Naeema Houri<sup>a#</sup> and Maria Aldossari<sup>a#</sup>

<sup>a</sup> Nursing Affairs, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia.

## Authors' contributions

This work was carried out in collaboration among all authors. All authors read and approved the final manuscript.

## Article Information

Open Peer Review History:

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers, peer review comments, different versions of the manuscript, comments of the editors, etc are available here:

https://www.sdiarticle5.com/review-history/101347

## Original Research Article

Received: 05/04/2023

Accepted: 09/06/2023

Published: 15/06/2023

## ABSTRACT

**Background:** Understanding what factors contribute to fall-related injuries is essential for developing and implementing interventions aimed at eliminating such incidents in a tertiary hospital in Saudi Arabia.

**Purpose:** This study aims to determine the factors that contributed to patient falls resulting in injury among adult patients admitted to a tertiary hospital in Saudi Arabia.

**Methods:** We conducted a retrospective study of 89 adult patient falls incidents that resulted in injuries between January 2019 and September 2021. We evaluated the demographic, patient, provider, environmental, organizational, and sociocultural variables. Included in the analysis were descriptive statistics, frequency, median, and interquartile range (IQR). The relationships between injury levels and key variables were evaluated using the chi-square test where $P \le 0.05$ was considered statistically significant.

**Results:** A high percentage of patient falls resulting in injury were unwitnessed/unassisted (87.64%). Patients who sustained injuries from the fall have an age range of 38 years and older and are predominantly male (61.80%). All serious injuries were sustained by those aged 58 years and

<footnote>++ Quality Analyst;</footnote>

<footnote># Nursing Quality Improvement Coordinator;</footnote>

<footnote>*Corresponding author: Email: bacalsolemon@gmail.com;</footnote>
older (100%). The majority of patients had low levels of hemoglobin (92.13%). The association between the environment and injury level was found to be highly statistically significant (x²=21.12, P value=0.002). The median time between physician was notified and physician's response was 20 minutes, with an interquartile range of 1 hour and 7 minutes.

**Conclusion:** We emphasize the importance of including the older age, gender, and hemoglobin in screening and preventative measures aimed at preventing fall-related injuries. In addition, a physician's prompt response is essential for preventing the initial injury from deteriorating further.

Keywords: Falls with injury; unwitnessed fall; unassisted falls.

# 1. INTRODUCTION

The National Database of Nursing Quality Indicators (NDNQI) defines patient fall as a sudden, unintentional descent, with or without injury to the patient, that results in the patient coming to rest on the floor, on or against some other surface (e.g., a counter), on another person, or on an object (e.g., a trash can). Fall-related injuries are classified as minor, moderate, major, and death [1]. Patient falls and associated injuries are regarded as nursing-sensitive indicators because the prevention of falls is contingent on the quantity and quality of nursing care. The National Database of Nursing Quality Indicators (NDNQI) published a report on adult inpatient fall rates between 2018 and 2020, revealing that the mean injury fall rate per 1,000 patient days ranged between 0.46 and 0.60.

Injuries caused by patient falls are a serious problem in hospitals around the globe. It affects the patient's quality of life. Even soft tissue injuries and minor fractures can cause significant functional impairment, discomfort, and distress in frail and functionally vulnerable individuals. These ostensibly "minor" injuries, or falls resulting in no physical harm, can mark the beginning of a negative cycle in which a senior's dread of falling causes him or her to limit activity, resulting in further loss of strength and independence [2]. There are numerous evidence-based falls prevention measures and risk assessments, however, there is little evidence that helps identify and intervene with patients who are more likely to sustain injuries from a fall. In Saudi Arabia, understanding what factors including the predictors prior to injurious falls remains unclear. As a consequence, the treatment of fall injuries is extremely expensive, further increasing the burden on the healthcare economy. What is more concerning are the debilitating effects of the injury to the lives of the patients wherein they suffer lifelong disabilities

and psychological trauma after sustaining moderate to major fall injuries.

In King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh, Saudi Arabia, the falls with injury rate per 1,000 patient days for the previous eight quarters (3Q2019 – 2Q2021) ranged from 0.10 to 0.22, outperforming the NDNQI's eight-quarter benchmark of 0.40 to 0.51. KFSH&RC is a Magnet-designated hospital, requiring the organization to accomplish five out of eight quarters of superior performance for falls with injury indicator. Although these numbers do not affect the hospital's performance in sustaining Magnet standards, they continue to represent the number of patients who sustained injuries from the fall. This study's objective was to investigate and determine the factors that contributed to adult inpatient falls resulting in injury. This study utilized the Quality Information System (QIS), the Integrated Clinical Information System (ICIS), and the Fall Event Review Tool to collect the data and identify pertinent factors regarding why certain adult patients are more likely to sustain injuries from a fall. This study included all adult patients admitted in an adult inpatient units aged 18 years old and above who sustain injuries from a fall, regardless of injury severity.

## 1.1 Nursing Implications

The fall risk assessment (FRA) tools used by nurses in the hospital are specific in assessing patients who are most likely to fall and classify risk levels. It does not, however, determine who is most likely to be injured from a fall. Although the objective of FRAs is to prevent falls, this study provided us with a clear comprehension of the factors that would increase the patient's risk of injury from a fall. This study's findings indicated a critical need to institute fall injury risk screening and prevention programs with the key variables to consider.
## 2. METHODS

### 2.1 Purpose

This study aims to determine the factors that contributed to patient falls resulting in injury among adult patients admitted to King Faisal Specialist Hospital & Research Center in Riyadh, Saudi Arabia.

### 2.2 Study Design and Sampling

A retrospective study was a design used to analyze the case series of patient falls with injury incidents in King Faisal Specialist Hospital & Research Center in Riyadh, Saudi Arabia. The inclusion criteria were adult patients aged 18 years old and above admitted across all adult inpatient areas that sustained injury from the fall. On the other hand, the exclusion criteria were from pediatric patient population aged 17 years and below from across all inpatient areas, including pediatric and adult Outpatient and Emergency Department. This retrospective study included all adult patient falls with injury incidents that occurred from January 2019 – September 2021. All of the 89 incidents were eligible samples of the study.

### 2.3 Data Collection

The data collection procedure commenced with the electronic entry of a patient fall incident into the Quality Information System (QIS). A QIS report and the patient's medical record were reviewed by a Nursing Quality Analyst and a Nursing Quality Improvement Coordinator who were trained and experienced in defining falls and fall-related injuries after a clinician entered a fall incident. On the Integrated Clinical Information System (ICIS), the Medical Record Number (MRN) for each incident has been validated via a review of demographics and documentation. The Analyst and Coordinator validated the report's veracity, including the severity level of the injury according to National Database for Nursing Quality Indicators (NDNQI) definition and guidelines for patient falls. Each incident report's investigation progress notes, document attachments, findings, and conclusion were stored in the QIS. The accounting for all validated and closed patient falls with injury incidents are linked to the Organization's Zero Harm Scorecard Dashboard.

In this investigation, we retrospectively examined all patient falls closed incidents resulting in

injuries that occurred between January 2019 and September 2021. All required medical record data was collected retrospectively without direct patient contact using the Fall Event Review Tool, a hospital-specific adaptation of the Agency for Healthcare Research and Quality's patient falls data collection form [3]. This instrument included the demographic, patient, provider, environmental, organizational, and sociocultural independent variables. The QIS, ICIS, and Zero Harm Scorecard Dashboard were the hospital electronic systems utilized to collect all of the necessary information and data, including validation results.

### 2.4 Statistical Analysis

Data collected in the fall event review tool were entered in Redcap app, and the final data were extracted in Microsoft Excel (version 2016) sheet. Data analysis was carried out in STATA 17.0 (StataCorp LP, College Station, TX, USA) software package. Analysis included descriptive statistics, frequency tables in numbers and percentages, when considered necessary, the median and interquartile range (IQR) were used. The associations between variables were tested through the chi-square test, a suitable test for significance where P≤0.05 was regarded as statistically significant.

## 3. RESULTS AND DISCUSSION

Fig. 1 shows the distribution of injured patients according to the severity of their injuries. In this study, the vast majority of patients (N= 72, 81%) sustained minor injuries, followed by major (N= 9, 10%) and moderate (N=8, 9%) injuries.

Fig. 2 represents the sociodemographic age characteristic based on the severity of injuries. Patients' ages ranged from 38 and above, and patients aged 58 and older sustained all serious injuries.

Table 1 shows the distribution of sociodemographic gender characteristics of patients. Males (N=55, 61.80%) sustained more injuries regardless of severity than females (N=34, 38.20%).

Table 2 shows the distribution of the unit population is illustrated. The population of patients admitted to the Medical/Surgical unit sustained the highest percentage of fall-related injuries (N=20, 22.47%)
<figure><img src="image_3.png" /><figcaption>Fig. 1. Distribution of injured patients according to the severity of their injuries</figcaption></figure>

<figure><img src="image_4.png" /><figcaption>Fig. 2. Sociodemographic age characteristic based on the severity of injuries</figcaption></figure>

<table><caption>Table 1. Distribution of sociodemographic gender characteristics of patients</caption><thead><tr><td>Gender</td><td>Frequency (N)</td><td>%</td></tr></thead><tbody><tr><td>Male</td><td>55</td><td>61.80%</td></tr><tr><td>Female</td><td>34</td><td>38.20%</td></tr><tr><td>Total</td><td>89</td><td>100%</td></tr></tbody></table>

Table 3 indicates patient falls with injury associated factors. The majority of falls resulting in injury were unwitnessed (N=78, 87.64%) and occurred with a sitter present (N=55, 62.50%), while history of falls (N=8, 8.99%) and physiologic falls (N=11, 12.36%) were less common.

Table 4 shows patient vital signs prior to fall. Prior to fall occurrence, the majority of patients have normal vital signs, including normal oxygen saturation (N=88, 98.88%), normal temperature (N=77, 86.52%), normal pulse rate (N=72, 80.90%), normal respiration (N=72, 80.90%), and normal blood pressure (N=73, 82.02%). The

finding was described according to the vital signs reference range used by the hospital.

Table 5 reveals patients' blood test results. Majority of patients had low hemoglobin count (N=82, 92.13%), and low Red Blood Cell Count (RBC) (N=74, 83.15%), whereas more than three quarters (N=68, 76.40%) had normal albumin level. The finding was described according to the reference range used by the hospital.

Table 6 shows the exact location of the falls. The highest frequency of patient falls based on exact location was in the patient's room (N=52, 58.43%) and in the bathroom (N=37, 41.57%), whereas there was no occurrence of falls in the hallway or nursing station.

Table 7 shows distribution of factors related to involved patients attempting to do before fall. The highest percentage was patients who were going to the bathroom (N=19, 21.5%), followed by getting out of bed (N=18, 20.22%) and walking
(N=16, 17.98%), whereas the lowest was reaching for object (N=1, 1.12%) and standing still (N=5, 5.62%).

Table 8 shows association between environment and injury level. There was highly significant association between environment and injury level (x^2=21.12, P value=0.002)

Table 9 shows the duration of time between physician was notified and response. The median duration was twenty minutes and the interquartile range was 1 hour and 7 minutes. The result was calculated based on the 50 out of 89 cases who showed to have nurses reported the incidents to the primary physician.

In this study, we determined specific variables that contributed to adult patient fall injuries in a tertiary hospital in Riyadh, Saudi Arabia. It was determined that patients who sustained injuries from fall incidents were 38 years of age and older. All major injuries were sustained by older adults 58 years and older. Visual impairment, gait or mobility impairment, and balance impairment have all been associated with advancing age that are common causes of patient falls for older age patient population [4]. Chronic illnesses, decreased muscle strength from arthritic joints, physical frailty in which walking speed is reduced, sarcopenia associated with loss of muscle mass and strength, and the dangers of immobility are common factors

affecting gait in older adults. In addition, the older person's ability to regulate posture and avoid falling after an unexpected slip decreases with age [4]. In a separate study conducted in Saudi Arabia has cited that vision, hearing, and memory impairments associated with aging tend to increase the number of trips and falls [5]. Considering these factors associated with aging, our findings indicated that elderly patients aged 58 years and older who fall are more likely to sustain serious injuries than younger patients.

Majority of patients who sustained higher number of injuries were men compared with women. This finding was consistent with another study in Jeddah, Saudi Arabia that the occurrence of falls with injury occurred mostly in men than women [5]. A 2018 study related to understanding sex differences in fall circumstances revealed that men were likely than women to fall from loss of support with an external object, like a cane or chair [6]. The outcome of patient fall with injury for men in Saudi Arabia could be attributed to socio-cultural views on gender as men being perceived as gender of physical strength who are less likely inclined to ask for help or assistance compared with women. Because of this notion, male patients tend to disregard support for walking or choose not to call for assistance when they attempt to ambulate. Without using any support, it could contribute to more fall with injury frequency among men than women.

<table><caption>Table 2. Distribution of the unit population</caption><thead><tr><th rowspan="2">Unit Type</th><th colspan="3">Injury level</th><th rowspan="2">Total</th></tr><tr><th>Minor</th><th>Moderate</th><th>Major</th></tr></thead><tbody><tr><td>Adult Bone Marrow Transplant</td><td>7</td><td>1</td><td>2</td><td>10</td></tr><tr><td>Cardiovascular</td><td>6</td><td>0</td><td>0</td><td>6</td></tr><tr><td>Oncology</td><td>13</td><td>4</td><td>2</td><td>19</td></tr><tr><td>Organ Transplant</td><td>12</td><td>1</td><td>1</td><td>14</td></tr><tr><td>Medical/Surgical</td><td>15</td><td>2</td><td>3</td><td>20</td></tr><tr><td>Neurosciences</td><td>10</td><td>0</td><td>0</td><td>10</td></tr><tr><td>Orthopedics</td><td>1</td><td>0</td><td>0</td><td>1</td></tr><tr><td>Others</td><td>8</td><td>0</td><td>1</td><td>9</td></tr></tbody><tfoot><tr><td>Total</td><td>72</td><td>8</td><td>9</td><td>89</td></tr></tfoot></table>

<table><caption>Table 3. Patient falls with injury associated factors</caption><thead><tr><th>Factor</th><th>Yes N (%)</th><th>No N (%)</th><th>Unknown N (%)</th><th>Total</th></tr></thead><tbody><tr><td>History of Falls</td><td>8 (8.99%)</td><td>79 (88.76%)</td><td>2 (2.25%)</td><td>89 (100%)</td></tr><tr><td>Physiologic Falls</td><td>11 (12.36%)</td><td>73 (82.02%)</td><td>5 (5.62%)</td><td>89 (100%)</td></tr><tr><td>Witnessed Falls</td><td>9 (10.11%)</td><td>78 (87.64%)</td><td>2 (2.25%)</td><td>89 (100%)</td></tr><tr><td>Sitter is present</td><td>55 (62.50%)</td><td>5 (5.68%)</td><td>28(31.82%)</td><td>89 (100%)</td></tr></tbody></table>
<table><caption>Table 4. Patient vital signs prior to fall</caption><thead><tr><th>Vital sign</th><th>Reference range</th><th>Low (Below the reference range) N (%)</th><th>Normal (Within the reference range) N (%)</th><th>High (Above the reference range) N (%)</th><th>Unknown N (%)</th><th>Total N (%)</th></tr></thead><tbody><tr><td>Blood sugar</td><td>3.9 - 6.9 mmol</td><td>0 (0%)</td><td>16 (17.98%)</td><td>26 (29.21%)</td><td>43 (52.81%)</td><td>89 (100%)</td></tr><tr><td>Oxygen Saturation</td><td>85%-100%</td><td>1 (1.12%)</td><td>88 (98.88%)</td><td>0 (0%)</td><td>0 (0%)</td><td></td></tr><tr><td>Temperature (Oral)</td><td>36 - 37.5 degrees celcius</td><td>2 (2.25%)</td><td>77 (86.52%)</td><td>10 (11.24%)</td><td>0 (0%)</td><td>89 (100%)</td></tr><tr><td>Pulse</td><td>55 - 100 beats per minute</td><td>6 (6.74%)</td><td>72 (80.90%)</td><td>11 (12.36%)</td><td>0 (0%)</td><td>89 (100%)</td></tr><tr><td>Respiration</td><td>12 - 20 cycles per minute</td><td>0 (0%)</td><td>72 (80.90%)</td><td>17 (19.10%)</td><td>3 (3.37%)</td><td>89 (100%)</td></tr><tr><td>Blood pressure</td><td>90/60mmhg - 130/90 mmhg</td><td>2 (2.25%)</td><td>73 (82.02%)</td><td>14 (15.73%)</td><td>0 (0%)</td><td>89 (100%)</td></tr></tbody></table>

<table><caption>Table 5. Patients' blood test results</caption><thead><tr><th>Blood test</th><th>Reference Range</th><th>Low (Below the reference range) N(%)</th><th>Normal (Within the reference range) N(%)</th><th>High (Above the reference range) N(%)</th><th>Unknown N(%)</th><th>Total N(%)</th></tr></thead><tbody><tr><td>WBC</td><td>3.90 - 11.0 10<sup>9</sup>/L</td><td>13 (14.61%)</td><td>61 (68.54%)</td><td>15 (16.85%)</td><td>0 (0%)</td><td>89 (100%)</td></tr><tr><td>RBC</td><td>3.90 - 4.60 10<sup>12</sup>/L</td><td>74 (83.15%)</td><td>14 (15.73%)</td><td>1 (1.12%)</td><td>0 (0%)</td><td>89 (100%)</td></tr><tr><td>Hemoglobin</td><td>Female: 110 - 160 g/L<br>Male: 135 - 180 g/L</td><td>82 (92.13%)</td><td>6 (6.74%)</td><td>1 (1.12%)</td><td>0 (0%)</td><td>89 (100%)</td></tr><tr><td>Platelet</td><td>155 - 435 10<sup>9</sup>/L</td><td>36 (40.45%)</td><td>50 (56.18%)</td><td>2 (2.25%)</td><td>1 (1.12%)</td><td>89 (100%)</td></tr><tr><td>Potassium</td><td>3.5 - 5.0 mmol/L</td><td>12 (13.48%)</td><td>73 (82.02%)</td><td>3 (3.37%)</td><td>1 (1.12%)</td><td>89 (100%)</td></tr><tr><td>Sodium</td><td>135 - 147 mmol/L</td><td>25 (28.09%)</td><td>64 (71.91%)</td><td>0 (0%)</td><td>0 (0%)</td><td>89 (100%)</td></tr><tr><td>Calcium</td><td>2.10 - 2.60 mmol/L</td><td>36 (40.45%)</td><td>38 (42.70%)</td><td>2 (2.25%)</td><td>13 (14.61%)</td><td>89 (100%)</td></tr><tr><td>Magnesium</td><td>0.70 - 1.00 mmol/L</td><td>19 (21.35%)</td><td>60 (67.42%)</td><td>1 (1.12%)</td><td>9 (10.11%)</td><td>89 (100%)</td></tr><tr><td>Albumin</td><td>40 - 50 g/L</td><td>11 (12.36%)</td><td>68 (76.40%)</td><td>10 (11.24%)</td><td>0 (0%)</td><td>89 (100%)</td></tr></tbody></table>
<table><caption>Table 6. Exact location of incident</caption><thead><tr><th>Exact Location of Incident:</th><th>N</th><th>%</th></tr></thead><tbody><tr><td>Patient's Room</td><td>52</td><td>58.43%</td></tr><tr><td>Bathroom</td><td>37</td><td>41.57%</td></tr><tr><td>Hallway</td><td>0</td><td>0%</td></tr><tr><td>Nursing Station</td><td>0</td><td>0%</td></tr><tr><td>Total</td><td>89</td><td>100%</td></tr></tbody></table>

In terms of patient population, adult patients admitted in the medical/surgical and oncology units sustained higher number of patients fall with injury incidents compared with other units. This finding correlates with another study wherein medical/surgical units have higher patient fall with injury incidents in USA. Twenty percent of medical/surgical unit falls result in some injury, while 2% result in serious injuries [7]. Another study found that many patients with cancer have higher risk for falls and injury due to multiple and specific risk factors because of cancer symptoms and treatment side effects [8].

Previous studies have identified that history of falls is one of the risk factors for patient falls. Some fall risk assessment tools included fall history as one of the variables being assessed in determining the patient level of risk. However, our finding showed that majority of the patients who sustained injury from the fall had no history of fall. This is evidence that history of fall is not a reliable variable to determine the injury risk in particular. Although the aim of fall risk assessment tools is to prevent patient falls regardless of the outcome, this finding suggested that history of fall has no significance in determining the level of injury risks from a fall.

However, the majority of patient falls resulting in injury were not witnessed. Unwitnessed falls were falls that occurred when the patient was alone and no other person was present to observe the fall or assist the patient. A 2014 study concluded that unassisted falls are more

likely to result in injury than assisted falls and should be the focus of future prevention efforts [9].

Prior to falling, the majority of patients' vital signs were normal, according to an analysis of their measurements. Gray-Miceli [4] provided evidence that orthostatic hypotension is a common intrinsic factor that may result in loss of balance and increase the patient's risk of collapsing. However, our investigation revealed that vital signs are unrelated to patient falls with injuries.

The majority of patients had insufficient hemoglobin and Red Blood Cell (RBC) counts, which was indicative of anemia, as determined by the blood test results. Interestingly, numerous studies have only linked patient injuries to anemia in old age. However, our finding indicated that patients with anemia, regardless of age in the maturity stage, are more likely to sustain a fall-related injury. This finding was consistent with the findings of a previous study conducted in Jeddah, Saudi Arabia, in which researchers discovered that a significant proportion of patients who sustained a fall-related injury had a history of anemia [5].

<table><caption>Table 7. Distribution of factors related to involved patients attempting to do before fall</caption><thead><tr><th>What was the involved patient attempting to do?</th><th>N</th><th>%</th></tr></thead><tbody><tr><td>Getting out of bed</td><td>18</td><td>20.22%</td></tr><tr><td>Standing Still</td><td>5</td><td>5.62%</td></tr><tr><td>Wheeling in wheelchair</td><td>0</td><td>0%</td></tr><tr><td>Walking</td><td>16</td><td>17.98%</td></tr><tr><td>Reaching for object</td><td>1</td><td>1.12%</td></tr><tr><td>Transferring to/from chair or wheelchair</td><td>6</td><td>6.74%</td></tr><tr><td>Going to the bathroom</td><td>19</td><td>21.35%</td></tr><tr><td>Unknown</td><td>14</td><td>15.73%</td></tr><tr><td>Other</td><td>10</td><td>11.24%</td></tr><tr><td>Total</td><td>89</td><td>100%</td></tr></tbody></table>

<table><caption>Table 8. Association between environment and injury level</caption><thead><tr><th rowspan="2">Environment:</th><th colspan="3">Injury level</th><th rowspan="2">Chi-square test</th></tr><tr><th>Minor</th><th>Moderate</th><th>Major</th><th>total</th></tr></thead><tbody><tr><td>Wet floor</td><td>9</td><td>0</td><td>2</td><td>11</td><td>Person chi2 (6) = 21.1233</td></tr><tr><td>Footware</td><td>0</td><td>0</td><td>1</td><td>1</td><td>Pr=0.002*</td></tr><tr><td>IV Lines attached</td><td>0</td><td>1</td><td>0</td><td>1</td><td></td></tr><tr><td>Unknown</td><td>63</td><td>7</td><td>6</td><td>76</td><td></td></tr><tr><td>Total</td><td>72</td><td>8</td><td>9</td><td>89</td><td></td></tr></tbody></table>
<table><caption>Table 9. Duration of time between physician was notified and response</caption><thead><tr><td>Time physician was notified</td><td>Time physician responded</td><td>Duration of time</td></tr></thead><tbody><tr><td>09:30</td><td>10:57</td><td>01:27</td></tr><tr><td>11:10</td><td>11:35</td><td>00:25</td></tr><tr><td>8:05</td><td>8:15</td><td>00:10</td></tr><tr><td>13:30</td><td>13:40</td><td>00:10</td></tr><tr><td>00:00</td><td>00:25</td><td>00:25</td></tr><tr><td>11:05</td><td>11:05</td><td>00:00</td></tr><tr><td>01:11</td><td>02:02</td><td>00:51</td></tr><tr><td>15:45</td><td>15:55</td><td>00:10</td></tr><tr><td>16:00</td><td>16:36</td><td>00:36</td></tr><tr><td>22:00</td><td>23:18</td><td>01:18</td></tr><tr><td>02:00</td><td>02:20</td><td>00:20</td></tr><tr><td>21:15</td><td>22:08</td><td>00:53</td></tr><tr><td>12:19</td><td>15:35</td><td>03:16</td></tr><tr><td>00:25</td><td>00:25</td><td>00:00</td></tr><tr><td>07:35</td><td>08:19</td><td>00:44</td></tr><tr><td>12:00</td><td>13:30</td><td>01:30</td></tr><tr><td>13:00</td><td>14:16</td><td>01:16</td></tr><tr><td>16:50</td><td>17:19</td><td>00:29</td></tr><tr><td>16:04</td><td>16:04</td><td>00:00</td></tr><tr><td>09:51</td><td>09:51</td><td>00:00</td></tr><tr><td>08:55</td><td>08:55</td><td>00:00</td></tr><tr><td>03:20</td><td>03:21</td><td>00:01</td></tr><tr><td>03:00</td><td>03:00</td><td>00:00</td></tr><tr><td>16:35</td><td>16:35</td><td>00:00</td></tr><tr><td>06:00</td><td>12:40</td><td>06:40</td></tr><tr><td>22:30</td><td>22:32</td><td>00:02</td></tr><tr><td>13:31</td><td>13:31</td><td>00:00</td></tr><tr><td>06:00</td><td>06:46</td><td>00:46</td></tr><tr><td>01:20</td><td>01:30</td><td>00:10</td></tr><tr><td>07:25</td><td>07:25</td><td>00:00</td></tr><tr><td>03:40</td><td>04:00</td><td>00:20</td></tr><tr><td>22:10</td><td>22:13</td><td>00:03</td></tr><tr><td>16:45</td><td>16:45</td><td>00:00</td></tr><tr><td>19:30</td><td>21:00</td><td>01:30</td></tr><tr><td>10:05</td><td>10:29</td><td>00:24</td></tr><tr><td>07:31</td><td>08:07</td><td>36:00</td></tr><tr><td>17:00</td><td>18:05</td><td>01:05</td></tr><tr><td>10:05</td><td>10:30</td><td>00:25</td></tr><tr><td>05:00</td><td>05:00</td><td>00:00</td></tr><tr><td>02:00</td><td>03:40</td><td>01:40</td></tr><tr><td>02:51</td><td>02:55</td><td>00:04</td></tr><tr><td>07:00</td><td>07:00</td><td>00:00</td></tr><tr><td>16:50</td><td>17:00</td><td>00:10</td></tr><tr><td>09:30</td><td>10:00</td><td>00:30</td></tr><tr><td>13:00</td><td>13:00</td><td>00:00</td></tr><tr><td>01:00</td><td>14:17</td><td>13:17</td></tr><tr><td>04:51</td><td>04:53</td><td>00:02</td></tr><tr><td>07:35</td><td>08:07</td><td>32:00</td></tr><tr><td>23:10</td><td>01:30</td><td>02:20</td></tr><tr><td>04:51</td><td>05:00</td><td>00:09</td></tr><tr><td>N</td><td>Median</td><td>Interquartile Range</td></tr><tr><td>50</td><td>0:20</td><td>1:07</td></tr></tbody></table>
The majority of patient falls resulting in injuries occurred in patient rooms as patients attempted to get out of bed and use the bathroom. The bathroom is another location where patient falls with injuries occur more frequently. This finding indicated that the environment was statistically highly significant in association with the injury level. Patients admitted to hospitals or residing in long-term care facilities are susceptible to falls in their environment. It may be necessary to modify the environment in order to prevent severe injury [4].

Also, the median time between time physician was notified and time physician responded was 20 minutes, with interquartile range of 1 hour and 7 minutes. As the patient's condition may alter rapidly, a timely and accurate assessment of fall and/or injury risk remains crucial [10]. In this study, the initial fall-related injury never worsened or deteriorated. This finding demonstrated that 20 minutes of response time was sufficient to manage the patient from the initial injury and prevent the injury from becoming more severe.

The findings of this study are significant in terms of understanding the associated factors related to falls with injury. The variables determined in this study such as older age, male gender and anemia provided us clarity as to what factors that contributed to fall injuries among adult patients admitted to King Faisal Specialist Hospital & Research Center. In addition, this study will aid us in forming policies, project improvements and other initiatives for fall-related injuries prevention in the hospital.

## 4. CONCLUSION

Older age 58 years old and above are more susceptible to major injury. Anemia, male patients and unwitnessed/unassisted falls can increase the likelihood of patients from sustaining injuries from the fall. Timely physician's response time is integral in preventing further deterioration of the initial injury. We highlight the urgent need for initiating interventions focused on preventing injuries from the fall, especially to include age, gender and hemoglobin in screening and preventative measures.

## 5. RESEARCH LIMITATIONS

We examined the case series of patient falls with injuries incidents that occurred in the past. This rendered the evidence of this study inferior

compared to prospective studies in which exposure is assessed at baseline and subjects are followed over time to examine the incidence of falls with injury. The study does not represent the general Saudi Arabian population as it was only conducted in one tertiary hospital.

## CONSENT

It is not applicable.

## ETHICAL APPROVAL

This research was conducted after the approval of the Research Ethics Committee of King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia, dated February 21, 2022.

## ACKNOWLEDGEMENT

The researchers express their gratitude to Dr. Edward Devol, and Norah Alnassar from the Research Office of King Faisal Specialist Hospital & Research Center for their expertise in helping the researchers analyze the data.

## COMPETING INTERESTS

Authors have declared that no competing interests exist.

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© 2023 Bacalso et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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