× You are not currently logged in. To receive all the benefits our site has to offer, we encourage you to log in now.

Why do patients in acute care hospitals fall? Can falls be prevented?

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Addie Abushousheh
Key Concepts/Context

Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals.


The objective of this study was to obtain the views of nurses and assistants as to why and how to overcome patient falls in acute care hospitals.


Basic content analysis methods were used to interpret descriptive data from four focus groups with nurses (n = 23) and four with assistants (n = 19) in four acute hospitals, two urban academic medical centers, and two suburban teaching hospitals in the same hospital system.

Design Implications
Incorporate a mechanism to systematically communicate current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Enhance visual cuing related to fall risk for direct care providers who may have a delay or not receive patient reports, such as a pictogram that depicts a nurse helping a patient to ambulate to the bathroom. Design patient rooms to minimize “clutter” and provide a visible and unobstructed path to the bathroom with easily accessible assistive devices. 

Positive and negative components of six concepts–patient report, information access, signage, environment, teamwork, and involving patient/family–formed two core categories: knowledge/communication and capability/actions that are facilitators or barriers, respectively, to preventing falls.


Linkage between risk assessments and individualized care plans were not determined. 

Design Category
Furniture, Fixtures & Equipment (FF&E)|Room configuration and layout
Outcome Category
Fall related outcomes|Staff productivity / efficiency
Environmental Condition Category
Key Point Summary Author(s):
Addie Abushousheh
Primary Author
Dykes, P. C.