Falls in Patients With Communication Disability Secondary to Stroke

The first results are in and can be found at the link below!

https://journals.sagepub.com/doi/10.1177/10547738221144214

TLDR: most common type of fall was an unwitnessed fall/roll from bed. Patient factors contributed to 50% of all falls. A third of falls a contributing factor couldn’t be identified due to patients communication disability & fall being unwitnessed. Limited insights to outcomes

The Study Overview:

The study, a mixed-methods medical record chart review, involved the examination of both retrospective and prospective data. It specifically focused on adult stroke patients with documented communication disabilities admitted to rehabilitation wards. In total, the research team screened 1,863 episodes of care and 99 patient admissions, eventually identifying 109 participants who met the inclusion criteria.

Demographics and Communication Disabilities:

The participants in this study had an average age of 75.5 years. The majority of them were non-ambulant and required full assistance for self-care tasks. Notably, the majority of participants had a severe communication disability as diagnosed by a speech pathologist. 

Protective/Prevention Factors:

Before the first fall occurred, 52 participants had personalized falls prevention strategies in place. These strategies typically included equipment such as equipment like floor line beds, bed/chair alarms, and high-visibility rooms. Additionally, some participants received support from family or visitors, contributing to their safety.

Contributing Factors and Hazards:

The study categorized the contributing factors for falls into four main groups: environmental factors, other human errors, patient-related factors, and medication, equipment, and documentation issues. Interestingly, patient-related factors were found to be the leading cause of falls, accounting for half of the total falls. Communication disability was directly associated with a small percentage of these falls. In nearly 1/3 of falls, a contributing factor could not be identified, because the fall was unwitnessed and the patient's communication disability meant they were unable to describe the fall. 

Circumstances of the Falls:

Rolling from a floor line bed emerged as the most common circumstance of a fall, responsible for nearly half of the falls in the study. Additionally, the majority of falls occurred within the patient's bedroom, and falls were more prevalent during the day and overnight periods.

Protective/Prevention Factors Following a Fall:

Post-fall, some participants received falls prevention education, while various strategies were introduced, including equipment and environmental changes to prevent future falls. However, it's essential to note that many patients continued to experience falls, even after preventive measures were implemented.

Patient Outcomes Following Falls:

The study revealed that injuries resulted from 15.2% of falls, ranging from fractures to lacerations. Moreover, some patients underwent additional investigations to assess injuries or potential physiological causes of falls, such as brain scans and X-rays. The emotional toll on patients, including suffering and fear of falling, was also reported but less frequently.

Organizational Outcomes Following Falls:

Organizational outcomes encompassed both financial and resource impacts. The study reported additional costs incurred for medical investigations and equipment hire, reflecting the financial impact of falls. Resource impact was also significant, as the added workload and scheduling disruptions affected staff and patient care.