The beginning of the journey to study patient safety and care quality in hospital settings using inpatient falls as an example

The purpose of this paper is to share with readers the beginning of my journey to study patient safety and care quality in hospital settings with a focus on inpatient falls. Studying patient safety and care quality can be overwhelming because of the breadth and depth of this subject and the many gaps that must be addressed to move nursing science forward. I used a graphic method,concept mapping,to capture my research journey. Data sources used in my program specific to inpatient falls for adults in hospital inpatient care include:(1) publicly available datasets;(2) published legal cases;(3) archived hospital data;(4) surveys;and (5) interviews,focus groups,observation,and field studies. I have summarized a series of my studies related to the relationship between nursing staff's response time to call lights and the prevalence or occurrence of inpatient falls in acute hospital settings. These studies illustrate the development of a line of research on inpatient falls. Finally,I discuss the pivotal points in pursuing this research and scholarship. To sustain the persistence and resilience on this journey requires passion for the subjects of patient safety and care quality.

Objective: To elucidate the epidemiological characteristics and to define some preventive strategies for fall injury (FI).Methods: The medical records of patients admitted following a fall from a certain height between August 1996and July 1997 were analyzed retrospectively.Results: A total of 138 patients were assessed, with a mortality of 31.2%. The male-to-female ratio was 3.5: 1.The persons between 20 and 59 years old were the main victims (81.8%), of which 52.2% were related with their work altitude. The remaining adults fall because of,accidents in daily life, suicide attempts, drug abuse,alcohol, or criminal behavior. There were significant differences between the death group and the survival group in the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) value (P ＜0.05 and P ＜0.01, respectively).Six children fall from balconies, open windows or roofs.There were significant differences for the height of fall and RTS value in aged group than those in children,adolescents, and adults (P ＜0.001, 0.005, 0.05; and P ＜0.05, 0.01, 0.05, respectively). The mortality of FI was significantiy correlated to the height of fall (r = 0.897, P ＜0.005).Conclusions: Male adults are the main victims,especially the workers at high altitudes. The mortality of FI is significantly correlated to the height of fall. The preventive strategies developed through analyzing the risk factors of fall in different age groups might reduce the injuries and deaths following fall.