# Emergency department volume metrics and the association with falls

## TL;DR

This study found that higher emergency department volume is linked to more patient falls, but boarding patients does not increase fall risk.

## Contribution

The study establishes a novel association between ED crowding and patient falls, while clarifying boarding's lack of impact.

## Key findings

- Higher ED volume at arrival correlates with increased fall risk (OR 1.013).
- Boarding patients do not significantly affect fall rates after adjusting for covariates.
- Fall rate was 0.12% across 393,876 ED visits.

## Abstract

Falls in hospitals are common and contribute to morbidity and resource utilization, with limited data from emergency departments (EDs). ED volumes are high with significant levels of crowding and inpatient boarders. The relationship between ED volume and falls is not yet established. We aimed to characterize the population of ED falls, and evaluate their relationship between crowding and boarding.

Retrospective cohort study from an academic ED in Boston, MA, USA, with 55,000 annual visits between April 1, 2016, and October 31, 2023. The primary outcome was the presence of a fall during the ED stay. We captured age, sex, emergency severity index (ESI) score, arrival times, chief complaint, and total ED volume and borders at the time of arrival. Bivariate associations between fall status and volume metrics among other covariates were calculated using chi-squared and 2-sample t-tests. A logistic regression model was built for each volume metric.

There were 393,876 total visits and 456 documented falls. The fall rate was 0.12%. With an adjusted odds ratio (OR) of 1.013 (95% CI, 1.004-1.022), the number of patients in the ED at the time of the fall was statistically significantly related to falls.

Increased ED volume at the time of patient arrival—a measure of crowding— is associated with an increased risk of falls for ED patients. Boarding does not have an association, even when controlling for demographics and chief complaints intuitively associated with falls. This information may help inform departments when to enact additional preventative measures.