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accidental falls, hospitals, measurement, reliability



  1. Simon, Michael
  2. Klaus, Susan
  3. Gajewski, Byron J.
  4. Dunton, Nancy


Background: Patient falls in hospitals are a performance measure endorsed by the National Quality Forum. Agreement of staff classifications of fall situations is not documented.


Objectives: The aims of this study were to (a) investigate how experts classify fall scenarios according to the fall definition of the National Quality Forum; (b) investigate how nursing staff classifies the same fall scenarios; and (c) assess the extent to which fall classifications differ among units, hospitals, and individuals.


Methods: Twenty video scenarios of falls were embedded in an online video survey. A panel of 24 experts and 6,342 hospital staff members from 362 units in 170 U.S. hospitals were asked to classify fall and nonfall scenarios. Experts consisted of nurses, physicians, physical therapists, and statisticians. Hospital staff were registered nurses (78%), unlicensed staff (15%), and other staff (7%).


Results: Experts unambiguously classified 14 out of 20 scenarios according to the National Quality Forum fall definition, whereas hospital staff clearly classified 12 scenarios. Experts and hospital staff did not agree on 4 out of 20 scenarios. The sensitivity was 0.90, the specificity was 0.88, and the mean probability for classifying a scenario as a fall was 0.60.


Discussion: Results indicate that the National Quality Forum fall definition needs further refinement to classify all scenarios properly. Although variability between individuals indicates some potential for fall reporting training, variability between units and hospitals does not seem to affect fall reporting.