Falls resulting in injury are consistently among the Top 10 sentinel events reported to The Joint Commission. The Agency for Healthcare Research and Quality estimates 700,000 to 1,000,000 hospital falls occur each year with 30–50% of falls resulting in injuries, like fractures and head trauma.
As with any adverse event in the hospital, a comprehensive fall investigation is crucial to determining causation as well as any appropriate measures that need to be taken to improve fall prevention strategies and safety procedures. Biomechanics can play a critically important role in these investigations.
Injury biomechanics explores human motion and how bone and soft tissue react to and tolerate external forces. While this area of scientific study plays an important role in the safe design of products and systems, including fall prevention technologies, it is especially useful in forensic investigations when it is necessary to determine if a fall injury happened as alleged (e.g., health product and premises liability lawsuits).
Forensic biomechanics becomes important in any case where there is a question of fall injury causation. For example, “slip, trip and fall” studies are helpful in investigations of incidents where an ambulatory patient falls after slipping or tripping while walking. Injury potential is a function of patient and environmental conditions and depends on fall mechanics and the subsequent impact.
A thorough investigation of a patient slip or trip event includes an examination of environmental conditions (e.g., floor slip resistance, cleanliness and obstacles), hospital policy compliance, the patient’s pre-existing injuries and fall biomechanics, which can be determined from witness and patient statements or video surveillance. Impact forces or injury mechanisms can then be evaluated and associated with risk of injury. These tools can also be applied to determine if the fall hazard actually caused the fall.
It is also critical to investigate the technologies involved in patient falls. For instance, if a patient falls from a ceiling mounted lift, the mechanical and electrical system components should be inspected, preventive maintenance and cleaning policies should be reviewed and staff should be interviewed. Investigations of a patient fall from a bed should consider the bed exit alarm, bed rail positions and the overall functionality, maintenance and cleaning of the bed. These events should be recreated in a timely manner to mitigate factual misinterpretation or forgetfulness and any components involved in the incident should be secured.
Without proper investigation, the hospital may miss an opportunity to improve fall prevention strategies and prevent future falls. Furthermore, if a patient sues the hospital, providers, or device manufacturers, the ensuing forensic analysis will become more difficult, if not impossible, to recreate.
To improve the quality of patient fall investigations, we recommend the following strategies:
- Collect all video surveillance of the area immediately. Some systems purge after 24 hours or less, thus evidence could be lost if not downloaded in a timely manner.
- Interview witnesses and record statements.
- Take photographs and measurements of the area where the fall occurred. Include overall photographs and close-ups of the floor and any associated technologies.
- Document reported injuries and retain medical records. Photograph superficial injuries if possible (abrasions, cuts and bruises) and their size, location, etc.
- Perform inspection of devices and the environment associated with the fall. Check for inspection and preventive maintenance records. Ensure that a robust maintenance program is in place based on accountability, frequency and verification.
- Evaluate relevant building code and life safety code requirements.
- Perform biomechanical analysis of the fall in conjunction with video analysis. If video is not available, use patient and witness recollection of the event and evidence from the fall scene.
Prior to beginning any investigation, always make sure that patient needs have been addressed and appropriate care has been provided. Also, in the interest of maintaining high reliability and preventing recurrence, it is important to integrate lessons learned from the investigation into fall prevention and resilience initiatives.
Reach out if you would like to learn more about fall investigation strategies, environmental and life safety code, or any of our other forensic investigative services.
