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Hill-Rom® Clinical Resource Center

Helping you implement evidence-based programs with connected technologies

Hill-Rom® Clinical Resource Center

Fall Prevention

Fall Prevention

  • Fall Prevention and bathroom safety in the epilepsy monitoring unit
    Spritzer SD, et al. | Epilepsy & Behavior | 2015

    Falls are one of the most common adverse events in the epilepsy monitoring unit, however, little is known regarding effectiveness of specific interventions due to variation in protocols and procedures between institutions. Over the course of 12 years, Mayo Clinic Arizona initiated several interventions to decrease falls and improve patient and caregiver safety resulting in a trend of decreasing fall frequency. However, no specific intervention could be identified as having a high impact on fall rates until the MasterVest™ ceiling lift system was put in place for use in all EMU patients when out of bed. Over 15 months after adopting the ceiling lift system, no falls occurred; preventing an expected 2.13 falls a year.

  • Preventing Falls and Eliminating Injury at Ascension Health
    Lancaster, Ava D. | The Joint Commission Journal on Quality and Patient Data | 2007

    Ascension Health achieved a 9.9% system wide reduction in falls by improving their processes and integrating Hill-Rom’s VersaCare bed and bed exit alarm. In addition, the rate of falls with serious injury decreased by 6.4% during the same period. This article outlines the four key strategies and supporting tactics used to accomplish this outcome.

  • Pragmatic, Cluster Randomized Trial of a Policy to Introduce Low-Low Beds to Hospital Wards for the Prevention of Falls and Fall Injuries
    Haines TP, et al. | Journal of the American Geriatrics Society | 2010

    This 6-month randomized trial evaluates the efficacy of a policy to utilize low-low beds for the prevention of falls and fall injuries on wards that had not previously accessed low-low beds. Analysis of the data revealed that  a policy for the use of low-low beds did not appear to reduce fall injuries due to the lack of a significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards.

  • Effects of Bed Height On the Biomechanics of Hospital Bed Entry and Egress
    Merryweather AS, et al. | Journal of WORK | 2015

    A large percentage of patient falls in hospitals occur near the bed, and yet little is known about the impact of bed height to fall risk. This study compared joint torques and angles during bed entry and egress at two heights. Twelve elderly adults (>55 year-old) with various ailments were selected who also had variety of strength and mobility limitations. Results show that at low bed height (38 cm), hip torque for bed entry was significantly higher, and hip, knee, and ankle flexion angles were significantly smaller. A full 50% of participants were unable to get out of the low bed without assistance. The authors conclude that low bed heights, which were were designed for the elderly with a high falling risk, pose safety risks for that population.

  • Inpatient fall prevention programs as a patient safety strategy: a systematic review.
    Miake-Lye IM, et al. | Annals of Internal Medicine | 2013

    This systematic review, including 4 meta-analyses involving 19 studies, shows that comprehensive fall prevention programs can help reduce the risk of inpatient falls by as much as 30%. Addressing the benefits and harms of fall prevention programs in an acute care setting, Miake-Lye identifies several factors crucial for the successful implemetation of the program including responsive leadership, staff engagement and pilot testing. 

  • Reducing patient falls: A call to action
    Jorgensen J | American Nurse Today | 2011

    Falls are the leading cause of injury-related deaths and the most common cause of injuries and hospital admissions in adults age 65 years and older. Fall-induced injuries result in prolonged hospitalization and staggering economic costs. The need for a comprehensive falls-reduction programs across the country has never been greater.

  • How to build a successful business case for a falls-reduction program
    Forte J | American Nurse Today | 2011

    Joan Forte examines the necessary components to  build a successful business case for a falls-reduction program. Following the nursing process of assess, plan, implement, and evaluate, this article guides nurses in creating a business case. 

  • Components of a comprehensive fall-risk assessment
    Kulik C | American Nurse Today | 2011

    Up to 50% of hospital patients are at risk for falls, and falling may result in injuries and prolonged hospital stays. Identifying patients who are at risk for falls by utilizing a comprehensive fall-risk program can significantly improve a hospital's fall rate. This article discusses the specific components of a fall-risk program including improved communication and education, regular reevaluation, mobility monitoring, and maintaing a safe enviroment.

  • Focusing on staff awareness and accountability in reducing falls
    Payson C | American Nurse Today | 2011

    Integrating fall prevention into a hospital's overall patient-centered care model holds staff members accountable for patient safety. By increasing accountability and awareness, a consistent approach to reducing falls and patient injuries is achieved. This article discusses the steps to achieve transparency and understanding of fall prevention and patient safety expectations amongst hospital employees. 

  • Creating a culture of safety: Building a sustainable falls-reduction program. The Magnet™ Model's five components can serve as the program's framework
    Wexler SS | American Nurse Today | 2011

    In order to create a culture of safety that sustains a fall-prevention program necessary for Joint Commission Accreditation, the authors recommend facilities utilize the Magnet™ Model of the Amercian Nurses Credentialing Center. This model puts the patient and family at the center of care and focuses on a nurse-patient relationship of postive and individualized treatment. 

  • Current and emerging innovations to keep patients safe. Technological innovations play a leading role in falls-prevention programs.
    Quigley P | American Nurse Today | 2011

    This article discusses the critical role technological innovation plays in healthcare organizations to promote patient safety and support fall-prevention programs. Various technologies are discussed including gait belts, bed and chair alarms, smart beds, mobility devices, walkers, and wheeelchairs. 

  • The Cost of Serious Fall-Related Injuries at Three Midwestern Hospitals
    Wong CA, et al. | Joint Commission Journal on Quality and Patient Safety | 2011

    This study was conducted using data from Barnes-Jewish Hospital, a 1,300-bed tertiary care teaching hospital located in St. Louis; Christian Hospital, a 493-bed acute care hospital located in north St. Louis County; and Missouri Baptist Medical Center, a 489-bed acute care hospital located in west St. Louis County.

  • Impact of the CMS No-Pay Policy on Hospital-Acquired Fall Prevention Related Practice Patterns
    Fehlberg EA, et al. | Innovation in Aging | 2018



    In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls. This study aimed to examine whether the CMS no-pay policy influenced four fall prevention practices: bed alarms, sitters, room changes, and physical restraints.

  • Cuttler Case Study

    To reduce the number of patient falls and the incidence of falls with injury, a two phase quality improvement program was initiated to improve patient safety, including patient education and use of Hill-Rom® VersaCare® beds with built-in, three-mode
    bed exit alarms. The fall rate decreased 23% and falls with moderate or major injury decreased by 58%.1 This fall prevention initiative has sustained improved outcomes for more than four years.

  • Preventing Falls Optimal Bed Height

    Falls are a problem
    Falls are the most commonly reported hospital adverse event1 in the adult inpatient setting and a single fall with serious injury costs the hospital on average $13,000.2
    Evidence-based protocols and equipment that help prevent falls improve patient safety and reduce cost.

  • VersaCare Reduced Fall Rate Case Study

    To improve efficiency and patient safety, a community acute care hospital stopped the use of disposable bed alarms in favor of built-in bed exit alert and bed safety status monitoring systems. To standardize equipment and protocols, 20 Hill-Rom® VersaCare® beds were implemented. Before implementation, the hospital’s
    medical and progressive care units were experiencing 1 fall every 10 days. After implementation, there were no falls reported during the 119-day follow-up period resulting in an estimated savings of $18,444 in fallrelated treatment costs. The hospital will save an estimated $55,000 annually by not purchasing, stocking, and discarding disposable bed alarms. Additionally, if the current reduction in fall rate is maintained, the facility will save up to $68,000 annually in fall-related treatment costs for a total annual savings of $123,000.

  • Preventing Falls in Hospitalized Patients: State of the Science.
    LeLaurin JH, Shorr R | Clinics In Geriatric Medicine


    Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall prevention interventions in hospitals. This article reviews common study designs and the evidence for various hospital fall prevention interventions. There is a need for more rigorous research on fall prevention in the hospital setting.

  • In-Hospital Sequelae of Injurious Falls in 24 Medical/Surgical Units in Four Hospitals in the United States.
    Hill AM, Jacques A, Chandler AM, Richey PA, Mion LC, Shorr RI. | Joint Commission on Accreditation of Healthcare Organizations | 2018



    Up to 50% of patient falls in the hospital result in injury. This study was conducted to determine whether injurious falls were associated with increased hospital length of stay (LOS), discharge to a place other than home, and in-hospital mortality.

  • Impact of Patient Safety Culture on Missed Nursing Care and Adverse Patient Events.
    Hessels AJ, Paliwal M, Weaver SH, Siddiqui D, Wurmser TA. | Journal of Nursing Care Quality.



    A strong patient safety culture (PSC) may be associated with improved patient outcomes in hospitals. The mechanism that explains this relationship is underexplored; missed nursing care may be an important link.

  • The Extra Resource Burden of in-Hospital Falls: a cost of falls study.
    Morello, et al. | The Medical Journal of Australia. | 2015


    Objective: To quantify the additional hospital length of stay (LOS) andcosts associated with in-hospital falls and fall injuries in acutehospitals in Australia.Design, setting and participants: A multisite prospective cohort studyconducted during 2011e2013 in the control wards of a falls prevention trial(6-PACK). The trial included all admissions to 12 acute medical and surgicalwards of six Australian hospitals. In-hospital falls data were collected frommedical record reviews, daily verbal reports by ward nurse unit managers,and hospital incident reporting and administrative databases. Clinicalcosting data were linked for three of the six participating hospitals tocalculate patient-level costs.

  • Unit-level Time Trends in Inpatient Fall Rates of US Hospitals
    He J, Dunton N, Staggs V. | Med Care | 2012


    Little is known about the recent development of the quality of nursing care.


    To examine trends in the rate of total inpatient falls, one of the nursing-sensitive quality indicators, in US hospitals.

  • Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care
    Staggs V, et al. | Jt Comm J Qual Patient Saf. | 2014


    Many hospitals classify inpatient falls as assisted (if a staff member is present to ease the patient’s descent or break the fall) or unassisted for quality measurement purposes. Unassisted falls are more likely to result in injury, but there is limited research quantifying this effect or linking the assisted/unassisted classification to processes of care. A study was conducted to link the assisted/unassisted fall classification to both processes and outcomes of care, thereby demonstrating its suitability for use in quality measurement. This was only the second known published study to quantify the increased risk of injury associated with falling unassisted (versus assisted), and the first to estimate the effects of falling unassisted (versus assisted) on the likelihood of specific levels of injury.

  • The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four US hospitals using archived hospital data
    Huey-Ming Tzeng, Marita G Titler2 , David L Ronis, and Chang-Yi Yin | BMC Health Services Research 2 | 2012



    Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day.

  • Falls among adult patients hospitalized in the United States: prevalence and trends
    Bouldin EL,et al. | Journal of Patient Safety | 2013



    The purpose of this study was to provide normative data on fall prevalence in U.S. hospitals by unit type and to determine the 27-month secular trend in falls before the implementation of the Centers for Medicare and Medicaid Service (CMS) rule, which does not reimburse hospitals for care related to injury resulting from hospital falls.

  • Prevalence and cost of imaging in inpatient falls: the rising cost of falling
    Fields J, et al. | ClinicoEconomics and Outcomes Research | 2015

    Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. 

  • Falls in hospital increase length of stay regardless of degree of harm
    Dunne TJ, et al. | Journal of Evaluation In Clinical Practice | 2014



    Acute inpatient falls are common and serious adverse events that lead to injury, prolonged hospitalization and increased cost of care. To determine the difference in total acute hospital care length of stay (LOS) for patients with and without an in-hospital fall (IHF), regardless of degree of harm.

  • Estimating the Cost of Serious Injurious Falls in a Canadian Acute Care Hospital
    Zecevic AA, et al. | Canadian Journal on Aging | 2012


    Falls represent 40 per cent of hospital accidents, and consequences range from none to serious injuries. The purpose of this study was to estimate the average hospital cost and length of stay (LOS) associated with serious injurious falls in an acute care hospital. We used data from risk management and case costing databases to identify cost associated with a serious injury after an in-hospital fall. Thirty-seven injured patients were matched with 2,113 controls by the most responsible medical diagnosis, age, and gender. Cost and LOS were compared using t-tests and multivariate regression.

  • Impact of Medicare's Nonpayment Program on Hospital-acquired Conditions.
    Thirukumaran CP, et al. | Medical Care | 2017



    Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program.


    To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load.

  • Effect of Medicare's Nonpayment for Hospital-Acquired Conditions Lessons for Future Policy
    Waters et al | JAMA Intern Med | 2017

    Importance—In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied.
    Objective—To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls.

  • AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons
    American Geriatric Society | 2010

    This multidisciplinary clinical practice guideline discusses barriers to and describes recommendations for the prevention of falls in the elderly in clinical practice.

  • Interventions for Preventing Falls in Older People in Care Facilities and Hospitals
    Cameron, ID, et al. | The Cochrane Collaboration | 2013

    This review included 60 randomised controlled trials involving 60,345 participants. Forty-three trials (30,373 participants) were in care facilities, and 17 (29,972 participants) in hospitals. Despite the large number of trials, there was limited evidence to support any one intervention.

  • Health Care Protocol: Preventing of Falls (Acute Care)
    Degelau J, et al. | Institute for Clinical Systems Improvement | 2008

    According the the National Center for Injury Prevention and Control, falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays. Falls are the most common adverse event reported in hospitals. The Institute for Clinical Systems Improvement (ICSI) Prevention of Falls Protocol  includes recommendations for a risk assessment for falls in hospitalized patients, and focuses on the strategies and interventions required for the prevention of falls and eventual elimination of falls with injury in acute care settings. The target population is adult patients in an acute care setting.

  • VA NCPS Toolkit
    Quigley P | Veterans Affairs (VA) | 2014

    The 2014 VA NCPS Falls Toolkit is designed for all facilities whether they already have a falls prevention program or would like to start one. There are several ways to use this toolkit. You can start on one of the scenarios listed below and turn to specific sections that you think will address your needs. You can also use the toolkit to develop information packets for patients and staff about falls and fall prevention.

  • Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care
    Ganz DA, et al. | cy for Healthcare Research and Quality (AHRQ) | 2013

    The 2013 AHRQ Hospital Fall Prevention Toolkit is a wonderful resource for those looking for a comprehensive resource to get started.  The toolkit provides evidence-based practices for fall prevention and injury reduction.  AHRQ specifically recommends developing care plans/goals, using a systematic approach or repeated assessment and adjustment and including robust analysis in a quality improvement program.

  • How-to Guide: Reducing Patient Injuries From Falls
    Boushon B, et al. | Institute for Healthcare Improvement | 2012

    The How-to Guide: Reducing Patient Injuries from Falls presents a promising new approach developed within the Transforming Care at the Bedside (TCAB) initiative. In 2006, eight hospitals with strong leadership commitment to a culture of innovation and a special interest in reducing injury from falls received RWJF grants to test, and measure comprehensive changes aimed at reducing patient injury from falls on medical and surgical units. In 2007, these hospitals continued to test innovations in falls and injury prevention in hospitals through a second IHI Falls Collaborative. During this time, key components for reducing falls-related injuries were specified for organization-level and unit-level programs. Unit-level strategies focused on assessment, intervention, and communication about fall risks, injury risks, and management.


  • Best Practice for Falls Reduction: A Practical Guide
    American Nurse Today | 2011

    This special report contains articles written by key thought leaders in fall prevention.  The document provides a review of programs, care processes, assessment methods and outcomes associated with fall prevention strategies.

  • Beyond the Falling Star: Sustained Decreases in Falls and Injuries with Targeted Bed Exit Alarm, Staff Education Icons, and Patient Education Video
    Cuttler, et al. | CALNOC | 2015

    Fall injuries among hospitalized inpatients are one of the most common hospital-acquired conditions. This study aimed to improve patient and staff awareness of falls through "falling star" icons and staff and patient education videos while, also examining the relationship between fall reduction and use of an integrated three-mode-bed-exit alarm. Over the course of 1,000 patient days, serious fall injuries were reduced by 58%. The patient education video and individualized "falling star" icons were associated with decreases in falls and fall-related injury.   

  • West Branch Regional Medical Center Reduces Fall Rate by 55% and Reduces Annual Fall-Related Costs by an Estimated 70%

    West Branch Regional Medical Center implemented initiatives to help reduce the number of patient falls by reinforcing prevention protocols and integrating 35 Hill-Rom® Advanta™ 2 beds. The fall rate decreased by 55% and the injury fall rate decreased by 27% with an estimated decrease in annual fall-related costs by 70%.

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