JHQ 302: The Combined Effect of Delirium and Falls on Length of Stay and Discharge-JHQ 302 Article

JHQ 302 Article

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This cross-sectional study examined how in-hospital delirium and patient falls—two common and often related adverse events—affect hospital length of stay (LOS) and discharge destination. Using electronic medical record and safety-event data from a 740-bed tertiary academic hospital, the authors analyzed 29,655 adult inpatient admissions (Aug 2018–Jan 2020). Patients were classified by whether they ever screened positive for delirium (via bCAM on wards or CAM-ICU in intensive care) and whether they experienced a reported fall during the admission.<br /><br />Delirium occurred in 3,707 admissions (12.5%) and falls in 286 admissions (0.96%); 36.7% of fallers also screened positive for delirium. Unadjusted outcomes showed substantial differences: median LOS was 4 days for patients with neither delirium nor falls, 8 days for falls only, 9 days for delirium only, and 22 days for those with both. Discharge to a facility (rather than home) similarly increased across groups: 9.9% (neither), 24.9% (falls only), 44.2% (delirium only), and 62.9% (both).<br /><br />After adjustment for demographics, comorbidities, ICU stay, medication orders, and other covariates, delirium and falls each independently prolonged LOS and increased facility discharge. Relative to patients with neither event, LOS was 1.64-fold longer with delirium only, 1.96-fold longer with falls only, and 2.84-fold longer when delirium and a fall co-occurred. For discharge to a facility, adjusted odds ratios were 3.49 (delirium only), 2.94 (falls only), and 8.98 (both).<br /><br />Although formal interaction terms were not statistically significant, the combined clinical impact of delirium plus falls was more than additive, identifying a particularly high-risk group. The authors conclude hospitals should integrate delirium screening, prevention, and management with fall-prevention efforts (e.g., targeted assessment and early mobility strategies) to improve outcomes and reduce LOS and post-acute facility placement.

Keywords

in-hospital delirium

patient falls

length of stay

discharge destination

facility discharge

cross-sectional study

electronic medical record data

CAM-ICU

brief Confusion Assessment Method (bCAM)

fall prevention and delirium screening integration