Cost Analysis of Falls: Importance for Doctors in Tertiary Hospitals
Cost analysis of falls is critical for doctors in tertiary hospitals because health services are investing considerable resources—estimated at AU$46 million annually across six health services in Australia (potentially AU$590 million nationally)—in fall prevention activities that may not be evidence-based or cost-effective. 1
Economic Impact of Falls in Hospitals
- Falls represent one of the most frequently occurring adverse events affecting older hospital inpatients, threatening both immediate and longer-term health outcomes and independence 2
- The short-term cost to a health service for a single cognitively intact patient who falls can be as high as AU$14,591 (2008 values), highlighting the significant financial burden falls place on hospital systems 2
- Medical costs increase proportionally with the degree of injury sustained, with third-degree injuries incurring the highest post-fall medical costs (averaging 18,257 New Taiwan dollars per patient) 3
Resource Allocation Concerns
- Current resource allocation for falls prevention shows significant variability across health services, with major resources being consumed by:
- Physiotherapy services (18%)
- Continuous patient observers (14%)
- Falls assessments and screens (12%)
- Falls prevention alarms (11%) 1
- Many of these resource-intensive activities have weak or little evidence of effectiveness, suggesting potential opportunities for more strategic resource allocation 1
Cost-Effectiveness of Targeted Interventions
- Targeted interventions based on accurate risk assessment can be more cost-effective than universal approaches:
- A multimedia patient education program with trained health professional follow-up cost A$526 (2008) to prevent one cognitively intact patient from falling 2
- This program showed a 52% probability of being both more effective and less costly than usual care alone 2
- When the proportion of cognitively intact patients falling under usual care is at least 4%, providing targeted education programs can both prevent falls and reduce costs 2
Impact on Length of Stay and Hospital Resources
- Patients who fall during hospitalization typically have significantly longer lengths of stay compared to matched non-fallers, particularly in high-risk diagnostic groups such as those with delirium, stroke, and respiratory conditions 4
- Hospital-related costs are substantially higher for fallers compared to non-fallers, especially for patients with stroke with severe/complicating diagnosis/procedure 4
- Effective screening using clinical judgment (such as physiotherapist assessment) can reduce falls by approximately 2.2 fallers per 100 inpatients and reduce resources spent on prevention and treatment by AU$2,704 per 100 inpatients compared to no intervention 5
Practical Implications for Doctors
- Understanding the cost implications of falls enables doctors to advocate for evidence-based prevention strategies that are both clinically effective and economically sound 1, 2
- Doctors should prioritize fall prevention activities for high-risk diagnostic groups where the economic impact of falls is greatest 4
- Resources currently allocated to potentially ineffective strategies could be redirected to interventions with stronger evidence bases, such as structured patient education programs 1
- Accurate risk assessment using clinical judgment can improve the cost-effectiveness of targeted interventions 5
Common Pitfalls to Avoid
- Investing in falls prevention equipment and strategies without evidence of effectiveness wastes valuable healthcare resources 1
- Failing to consider the cost-effectiveness of interventions may lead to suboptimal resource allocation 2
- Not targeting high-risk patient groups (such as those with dementia, delirium, or stroke) misses opportunities for significant cost savings 4
- Overlooking the potential for disinvestment in ineffective strategies prevents reallocation of resources to more effective interventions 1