Falls remain a source of preventable morbidity and mortality of hospitalized patients with acute medical illnesses. Because of the high cost associated with falls in dollars, length of stay, and patient outcomes, much research has focused on patient falls. However, much of this work has focused only on patients: identifying factors associated with a high risk of falls, assessing the risk of individual patients based on these factors, and creating interventions that decrease or attenuate these risks. The purpose of this study was to examine more closely both the circumstances and activities surrounding patient falls and the relationship between nurse staffing practices and falls.


We prospectively studied all falls on a single inpatient medicine ward from July 2005 to March 2006. A national Veterans Affairs standardized reporting form was used to collect information about each fall at the time it occurred. This form was locally adapted for the purposes of this study. We collected data regarding each patient's acuity using a standardized Veterans Affairs acuity score. Finally, we collected the following information about each nursing shift: number of nurses and nurses' aides, total number of nursing staff, time of the shift (ie, day, evening, or overnight), day of the week, census at its highest point during the shift, and average acuity of all patients on the ward.


Fifty‐eight falls occurred during the study period. The most typical situation was a man getting out of bed in the evening to go to the bathroom and “slipping.” Fifty percent of falls were associated with toileting, and 38% of falls occurred overnight, compared with 26% during the day. Twenty‐seven percent of falls occurred during shift changes. Falls tended to occur on Fridays, Saturdays, and Mondays.

Overall, falls occurred during 7% of shifts. Shifts with and without falls did not differ in the total number of nurses present or the average census. However, there was a difference in nurse‐to‐patient ratio (P = .04) and acuity (P = .02). Logistic regression adjusting for day of week, shift, and patient acuity demonstrated a significant relationship between staffing level and likelihood of falls (P = .03). For every increase in patient‐to‐nurse ratio of 0.5, there was a 10% increase in the likelihood of a fall occurring.


This study demonstrates that after adjustment for patient factors, higher nurse staffing ratios are associated with higher fall rates on an inpatient medicine ward.

Author Disclosure:

L. Leykum, None; C. Padgett, None; D. Gustke, None; D. Baruch Bienen, None; J. Patterson, None.