Evaluating Nursing Care Quality Through Inpatient Falls and Its Association With the Patient Experience: A Registry Study in Finnish Acute Care Settings

Background: The systematic collection and evaluation of evidence on the patient experience and the quality of care is crucial in advancing patient-centred safe care. This study examined the association of the incidence of injurious inpatient falls with the patient experience of nursing care in Finnish hospitals.

Aim(s): The aim was to determine how frequently inpatient falls occur, how patients evaluate their nursing care experience and whether these two factors are associated.

Methods: A cross-sectional registry study design was used. Data on inpatient falls, using hospital records and patient experience of nursing care, collected using the Nursing-Sensitive Patient-Reported Experience Measure (NsPREM), were collected in 2021 and 2022 from five university hospitals and four central hospitals in Finland. The data included a total of 4733 inpatient falls, of which 1899 were injurious, and 16,610 patient experience measures. Descriptive statistics were used to describe the incidence of inpatient falls and the patient experience, and linear mixed models were employed to examine the interaction between injurious inpatient falls and the patient experience. Analyses were conducted at a unit-type group level.

Results: Of the inpatient falls, 40% (n = 1899) caused injury and were statistically significantly associated with the patient experience measures, which are thus included in the linear mixed modelling. Overall, the patients experienced their care as excellent (with a mean greater than 4 on a five-point scale) in every unit-type group. Several subscales of NsPREM displayed associations with injurious inpatient falls. The patients were satisfied with nursing care on every subscale, particularly in terms of the courtesy and respect with which nurses treated them (mean: 4.83) and in terms of pain management (mean: 4.80). In linear mixed models, adjusting for injurious patient falls, the patients in psychiatric units reported that they were less satisfied with their care on every subscale compared with other unit-type groups: for example, the patients' experience of safety (Est. = -0.262, p < 0.001) and patient centredness (Est. = -0.399, p < 0.001) were significantly weaker in the psychiatric units.

Conclusions: The findings show that continuous improvement requires ongoing monitoring and the evaluation of strategies to reduce inpatient falls and improve patient satisfaction, and there is a need for the ongoing training of nursing staff and targeted interventions for high-risk patients. Hospital organisations must engage patients in their care, particularly in relation to fall prevention, to empower them and enhance their overall experience.