背景:住院患者的跌倒(FWH)增加了费用和住院时间。COVID-19大流行导致了更多的FWH。此外,COVID-19大流行导致隔离患者增加,来访者减少。以前尚未研究过它们与跌倒的关系。
方法:这是一个回顾性研究,单站点,大流行前12个月-大流行后12个月,观察性研究。使用多元逻辑回归分析对FWH结果以及与隔离和访客限制的关联进行建模。
结果:在研究期间的22,505例患者中,有4369例隔离事件和385例FWH。未经调整的分析显示,隔离放置者的FWH风险为1.33%(95%CI0.99,1.67),而无隔离事件放置者的FWH风险为1.80%(95%CI1.60,2.00)(χ2=4.73,P=0.03)。不同访客限制期的FWH风险显著高于前流行期(χ2=20.81,P<0.001),范围从流行病前期的1.28%(95%CI1.06,2.50)到大流行期间的2.03%(95%1.66,2.40),不允许访客(A阶段)。在调整了潜在的混杂因素和选择偏差后,仅A阶段访客限制与无访客限制相比,FWH风险增加0.75%(95%CI0.32,1.18).
结论:我们的结果表明,住院患者FWH风险与严重的访客限制之间存在中度强关联。该协会分阶段进行了沉默,甚至只有少量的探视津贴。这是访客限制政策对患者FWH风险的不利影响的第一份报告。
关于这个话题已经知道的是——医院中的病人事故占所有与医院相关的有害事件的4%。造成这些事故的危险因素很多,但很少有干预措施来降低他们的风险。在COVID-19大流行期间,病人事故的数量有所增加。虽然这种联系的原因尚不清楚,它们可能与COVID-19相关的干预措施有关,例如患者隔离和访客限制。这项研究补充了什么-这项探索性研究首次证明访客限制可能与患者事故风险增加有关。这项研究如何影响研究,实践或政策-当这些干预措施作为预防传染病传播和保护的捆绑战略的一部分时,应考虑访客限制的潜在有害影响。在医院中发生的患者事故导致需要治疗或延长住院时间的伤害对医疗保健非常重要,决策者和公众。1它们占所有与医院相关的有害事件的4%,并作为一项指标纳入了新的“医院危害措施”,作为急性医院护理的患者安全质量衡量标准,在加拿大实施了一项新的“住院风险评估”。自2020年3月13日在加拿大宣布COVID-19大流行以来,在2020-2021年和2021-2022年报告的每100住院患者中,患者的创伤事件增加了0.26这些预期的跌倒约占所有跌倒的30%,其余的是不可预防的,并且是由于意外或意外的跌倒.5在最近的系统评价和荟萃分析中,预防跌倒干预措施对医院成人跌倒结局的影响,患者和工作人员教育是唯一降低跌倒风险比(RR)0.70(95%CI0.51,0.96)和跌倒赔率比0.62(95%0.47,0.83)的干预措施,具有很高的确定性,虽然使用跌倒风险筛查工具进行早期分层,康复和运动疗法,辅助和报警装置,系统更改,如每小时四舍五入,和环境改变没有显示出任何好处。6一个特定的程序,秋季TIPS计划,7,8,利用访客的参与,以确保患者符合打印在层压海报或视觉辅助工具上的预防跌倒建议,显示跌倒减少了34%,提出了一种潜在的机制,通过这种机制,患者探访可能会减少患者的伤害。2020年3月11日,世界卫生组织(WHO)宣布COVID-19大流行。9为了防止COVID-19在加拿大医院的引入和传播,并防止患者和医疗保健提供者向访客传播,地区和地方公共卫生当局建议急性护理医院取消选择性诊所就诊,治疗,实施访客限制和加强COVID-19筛查和隔离方案。这些建议导致接触/液滴隔离预防措施中的患者数量增加,并且对患者访客的限制更加严格。其中许多建议在随后的大流行浪潮中进行了修订,因为许多人认为有些是无效的,可能是有害的。10-12例如,一些人认为患者访客不太可能是医院获得性COVID-19感染的重要来源.12作者得出结论,严格的患者访客限制可能阻止了很少的COVID-19感染,同时导致员工士气低落和患者预后恶化。从2019年到2020年,在美国BerylInstitute社区内的32家医院进行了一项回顾性的前后生态研究,未调整的院内跌倒伴髋部骨折率从2019年的0.03例(每1000例出院)增加到没有访客限制的医院。在2020年部分有限访问的医院中为0.07,在2020年具有绝对访客限制政策的医院中为0.14,13可能暗示与不同程度的访客限制相关的患者伤害信号。至于隔离住院患者人数的增加,一项系统评价指出,隔离做法与较少的患者-医护人员互动有关,延迟护理,14访客限制或患者隔离对FWH风险的影响尚未报道。10,11,14这是一项探索性研究,旨在确定隔离预防措施或访客限制与增加跌倒之间是否存在关联在急性护理社区医院住院的成年患者中具有伤害风险。
BACKGROUND: Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors. Their relationship with falls has not been previously studied.
METHODS: This is a retrospective, single-site, 12-month before pandemic-12-month after pandemic, observational study. Multiple logistic regression analysis was used to model FWH outcome and associations with isolation and visitor restrictions.
RESULTS: There were 4369 isolation events and 385 FWH among 22,505 admissions during the study period. Unadjusted analysis demonstrated a FWH risk of 1.33% (95% CI 0.99, 1.67) in those who were placed in isolation compared to 1.80% (95% CI 1.60, 2.00) in those without an isolation event ( χ2 = 4.73, P = 0.03). The FWH risk during the different visitor restriction periods was significantly higher compared to the prepandemic period ( χ2 = 20.81, P < 0.001), ranging from 1.28% (95% CI 1.06, 2.50) in the prepandemic period to 2.03% (95% 1.66, 2.40) with no visitors permitted (phase A) in the pandemic period. After adjusting for potential confounders and selection bias, only phase A visitor restrictions were associated with an increased FWH risk of 0.75% (95% CI 0.32, 1.18) compared to no visitor restrictions.
CONCLUSIONS: Our results suggest a moderately strong association between hospitalized patient FWH risk and severe visitor restrictions. This association was muted in phases with even minor allowances for visitation. This represents the first report of the adverse effects of visitor restriction policies on patients\' FWH risks.
What is already known on this topic – Patient accidents in hospitals account for 4% of all hospital-related harmful events. There are many risk factors that contribute to these accidents, but few interventions that reduce their risk. During the COVID-19 pandemic period, the number of patient accidents has increased. While the reasons for this association are unclear, they may be related to COVID-19-related interventions such as patient isolation and visitor restrictions. What this study adds – This exploratory study is the first to demonstrate that visitor restrictions may be associated with an increased risk of patient accidents. How this study might affect research, practice or policy – The potential harmful effects of visitor restrictions should be taken into consideration whenever these interventions are being implemented as part of a bundled strategy for prevention of infectious diseases transmission and protection. Patient accidents in hospitals resulting in harm requiring either treatment or prolonged hospital stay are of great interest to health care, policy makers and the general public. 1 They account for 4% of all hospital-related harmful events and are included as an indicator in the new Hospital Harm Measure instituted across Canada as a patient safety quality measure of acute hospital care. 2 Since the declaration of the COVID-19 pandemic in Canada on March 13, 2020, there were 0.26 patient trauma events per 100 hospitalizations reported in both 2020–2021 and 2021–2022, a 13% increase from 2019 to 2020. 3 In a population-based observational study conducted among Ontario patients hospitalized in 2015–2016, patient accidents were estimated to increase the index hospitalization length of stay by 17.3 days (95% CI 17.0, 17.6) and costs by $47824 (95% CI 47,383, 48,266) (CDN). 4 There have been over 400 clinical factors identified as being associated with an increased risk of falls in hospitalized patients. 5 Risk mitigation strategies have been implemented in many hospitals to prevent anticipatory falls defined as potentially preventable through early identification of patients that exhibit clinical signs associated with increased risk of falls. These anticipatory falls make up approximately 30% of all falls, with the remainder being nonpreventable and due to unanticipated or accidental falls. 5 In a recent systematic review and meta-analysis of the effects of falls prevention interventions on fall outcomes for adults in hospital settings, patient and staff education was the only intervention that reduced the fall rate risk ratio (RR) 0.70 (95% CI 0.51, 0.96) and the fall odds ratio 0.62 (95% 0.47, 0.83) with a high level of certainty, while early stratification using fall risk screening tools, rehabilitation and exercise therapies, assistive and alarm devices, system changes such as hourly rounding, and environmental modifications demonstrated no benefit. 6 One particular program, the Fall TIPS program, 7,8 which leverages visitor engagement to ensure that patients are compliant with fall prevention recommendations printed on a laminated poster or visual aid, demonstrated a 34% reduction in falls with harm, suggesting a potential mechanism through which patient visitation might reduce patient harm. On March 11, 2020, the World Health Organization (WHO) declared a COVID-19 pandemic. 9 In an attempt to prevent the introduction and spread of COVID-19 in Canadian hospitals and prevent transmission from patients and healthcare providers to visitors, regional and local public health authorities advised acute care hospitals to cancel elective clinic visits, treatments, and surgical procedures and implement visitor restrictions and enhanced COVID-19 screening and isolation protocols. These recommendations resulted in increased numbers of patients in contact/droplet isolation precautions and more severe patient visitor restrictions. Many of these recommendations were revised during the subsequent pandemic waves, as some were considered by many to be ineffective and potentially harmful. 10–12 For example, some have argued that patient visitors are unlikely to be an important source of hospital-acquired COVID-19 infection. 12 The authors concluded that severe patient visitor restrictions may have prevented few COVID-19 infections, while contributing to low staff morale and worse patient outcomes. In a retrospective before-after ecological study conducted at 32 hospitals within the Beryl Institute community in the United States from 2019 to 2020, the unadjusted in-hospital fall with hip fracture rates increased from 0.03 events (per 1000 hospital discharges) in 2019 in hospitals with no visitor restrictions, to 0.07 in hospitals with partial limited visitation in 2020, and to 0.14 in hospitals with absolute visitor restriction policies in 2020, 13 possibly suggesting a signal for patient harm associated with different levels of visitor restrictions. As for increased numbers of hospitalized patients in isolation, a systematic review noted that isolation practices are associated with less patient-healthcare worker interaction, delays in care, and increased symptoms of depression and anxiety. 14 The impact of either visitor restrictions or patient isolation on FWH risks has not been reported. 10,11,14 This is an exploratory study to determine if there is an association between either isolation precautions or visitor restrictions and increased falls with harm risk in adult patients hospitalized in an acute care community hospital.