A Five-Year Retrospective Study of Patient Falls in a Tertiary Hospital: Monitoring, Causes, and Impact on Patient Safety and Quality of Care

A Five-Year Retrospective Study of Patient Falls in a Tertiary Hospital: Monitoring, Causes, and Impact on Patient Safety and Quality of Care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Five-Year Retrospective Study of Patient Falls in a Tertiary Hospital: Monitoring, Causes, and Impact on Patient Safety and Quality of Care Hatice ESEN, Nazife ÖZTÜRK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7579750/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Jan, 2026 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background Falls in hospitalized patients are among the most common preventable adverse events and pose a major threat to patient safety. Despite preventive protocols, falls remain frequent and are associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Understanding the frequency, characteristics, and root causes of falls is essential to improve patient safety strategies. Aim This study aimed to examine the frequency and characteristics of inpatient falls over a five-year period and to identify their underlying causes through root cause analysis. Methods A retrospective descriptive study was conducted using hospital adverse event notification records between 2020 and 2024. A total of 211 fall incidents were identified and analyzed in terms of demographic characteristics, clinical settings, fall locations, risk scores, and root causes. The Itaki Fall Risk Scale was used to assess patient risk levels, and contributing factors were categorized into patient-related, caregiver-related, equipment-related, environmental, staff-related, and procedural causes. Results Among the 211 reported falls, the mean patient age was 50.4 ± 29.3 years, and most cases involved male patients (62.6%). The highest fall incidence was observed in 2024 (n = 78), indicating an increasing trend across the years. The majority of patients (92.4%) were classified as high risk according to the Itaki Fall Risk Scale. Most falls occurred in patient rooms (71.1%), followed by procedure/examination rooms (14.7%) and bathrooms/toilets (11.8%). Root cause analysis revealed that falls were primarily patient-related (59.7%), followed by caregiver-, equipment-, environmental-, staff-, and procedure-related factors. Conclusion Patient falls remain a significant safety concern in hospitals, with most cases occurring among high-risk patients and being preventable. Root cause analysis highlights the multifactorial nature of falls, emphasizing the need for comprehensive preventive strategies that address patient behavior, caregiver awareness, environmental safety, and staff compliance with protocols. Strengthening fall prevention programs is crucial to improving patient safety and reducing healthcare costs. Falls in hospitals patient falls patient safety root and cause analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Highlights - This study presents a five-year root cause analysis of inpatient falls in a tertiary training and research hospital. - The majority of falls occurred among high-risk patients aged 65–80 years and in male patients, with most events reported in patient rooms. - Patient-related factors, including cognitive impairment, polypharmacy, and lack of compliance with preventive measures, were identified as the primary causes of falls. - Despite preventive protocols, underreporting and insufficient patient/caregiver engagement remain critical challenges in fall prevention. - Findings emphasize the importance of systematic risk assessment, patient and caregiver education, and evidence-based fall prevention strategies to strengthen patient safety culture. Introduction Hospitals serve as the cornerstone of healthcare institutions, playing a central role in the health ecosystem by providing uninterrupted healthcare services [ 1 ]. Ensuring patient safety is the foremost priority for achieving high-quality, effective, and safe patient care [ 2 ]. The World Health Organization (WHO) defines patient safety as the absence of preventable harm to a patient during the process of healthcare [ 3 ]. Patient safety has become the most important priority for hospitals, with efforts directed toward establishing safer care environments where major complications are reduced [ 4 ]. Consequently, quality improvement practices and patient safety initiatives have emerged as fundamental goals of hospital management, making the implementation of specific preventive measures essential to achieving these objectives [ 1 ]. Hospital falls are among the most common and preventable patient safety incidents worldwide. A fall is defined as an unintentional descent to a lower level, regardless of whether an injury occurs [ 5 ][ 6 ][ 7 ][ 8 ]. Falls represent a major global safety concern. The WHO reports that approximately 37.3 million falls each year require medical attention, and around 684,000 people die annually due to falls [ 9 ][ 10 ][ 11 ]. Notably, the incidence of falls increases with age, with one in three adults aged 65 years and older experiencing at least one fall annually [ 12 ] [ 13 ]. Furthermore, approximately 600,000 fall-related deaths occur worldwide each year, making falls one of the leading causes of traumatic mortality [ 14 ]. Falls are also recognized as a leading cause of preventable injuries [ 15 ]. To reduce this risk, the WHO recommends creating safer environments, enhancing community education, increasing fall-related research, and developing appropriate prevention policies [ 11 ]. The causes of hospital falls are multifactorial, involving patient characteristics, caregivers, environmental factors, medications, and deficiencies in care processes, all of which can contribute to an increased risk [ 7 ][ 16 ]. Therefore, the use of risk assessment tools, the development of preventive protocols, and the implementation of root cause analyses are essential strategies to improve patient safety in clinical settings [ 17 ] [ 18 ] [ 19 ] [ 20 ] [ 21 ]. Nurses play a central role in fall-prevention strategies, and effective nursing practices have been shown to directly reduce the incidence of falls [ 22 ] [ 23 ][ 18 ] [ 15 ] [ 24 ] [ 25 ]. Most research to date has focused on identifying fall risks within the framework of global imperatives for prevention and management; however, interventions and preventive strategies for falls have not yet provided a universally accepted gold standard [ 26 ]. In this context, identifying the frequency, causes, and risk factors of hospital falls is essential to guide the development of effective fall-prevention programs. This study aimed to examine the frequency and characteristics of inpatient falls over a five-year period and to identify their underlying causes through root cause analysis. Methods Study Design This research was conducted as a descriptive study using retrospective data. Setting and Sample The study was carried out in a tertiary-level training and research hospital located in Antalya, Türkiye. Fall Risk Assessment Tools Identifying potential risk factors that may lead to patient falls during hospitalization is of critical importance [ 12 ]. According to the Turkish Ministry of Health’s Healthcare Quality Standards (HQS), risk assessments must be performed, fall incidents should be monitored, preventive measures should be implemented at patient, ward, and hospital levels, and outcomes should be followed using quality indicators [ 27 ], [ 28 ]. Within this framework, the Itaki Fall Risk Scale is used for adult patients, while the Harizmi Fall Risk Scale is applied to pediatric patients. The Itaki Fall Risk Scale evaluates 19 risk factors categorized as major or minor, and classifies patients into two groups: low risk and high risk [ 27 ][ 29 ]. In this study, the risk levels derived from the Itaki Scale (low vs. high) were used for analysis. Data Collection Data were retrospectively obtained from patient records covering the years 2020–2024. Information was collected using the “Patient Fall Data Collection Form” and the “Patient Fall Data Analysis Form,” which are implemented under the HQS framework of the Ministry of Health. Over the five-year period, data from 211 inpatients who experienced a fall during hospitalization were included in the study. Patient Fall Data Collection Form : includes patient name, age, gender, diagnosis, clinical unit, fall location, fall risk score, cause of fall, and pre-/post-fall patient status. Patient Fall Data Analysis Form : a mandatory hospital reporting tool completed monthly, which documents the number of hospitalized patients, number of falls, fall rates, locations of falls, and distribution of risk scores. The fall rate was calculated using the following formula defined by the Ministry of Health [ 30 ]: Number of patient falls Data were analyzed using Statistical Package for the Social Sciences (SPSS) Statistics version 22. Descriptive statistics included means, standard deviations, and frequency distributions. Group differences were examined using Chi-square tests, with statistical significance set at p < 0.05. Ethical Considerations This study was approved by Antalya Traning and Research Hospital Ethics Committee (Approval No: 2025/188, dated 19.06.2025) and conducted in accordance with the Declaration of Helsinki. This study used retrospective, anonymized patient safety data. No direct patient contact was involved. The requirement for individual informed consent was waived by the Ethics Committee. Limitations This study was conducted in a single center, which limits the generalizability of the findings to the national level. Findings During the five-year study period, a total of 211 inpatient falls were reported as adverse events. The lowest number of falls was observed in 2021 (n = 22), while the highest was recorded in 2024 (n = 78), indicating an upward trend over the years (Fig. 1 ). During the five-year study period, a total of 211 inpatient falls were reported as adverse events. The lowest number of falls was observed in 2021 (n = 22), while the highest was recorded in 2024 (n = 78), indicating an upward trend over the years (Fig. 1 ). The mean age of patients who experienced a fall was 50.43 ± 29.27 years, with the majority being male (62.6%). Falls were most frequently observed among patients in the 36–80 years age group (60.6%). The highest proportion of falls occurred in internal medicine clinics (43.1%), and according to the Itaki Fall Risk Scale, 92.4% of patients were classified as being at high risk for falls. In terms of fall locations, the majority occurred in patient rooms (71.1%), followed by procedure/examination rooms (14.7%) and bathrooms/toilets (11.8%). The overall inpatient fall rate across the years was approximately 0.01%. Root cause evaluation indicated that most falls (59.7%) were due to patient-related factors. Following the incidents, the majority of patients did not require additional diagnostic investigations (Table 1 ). Table 1 Characteristics of Patients Who Experienced Falls (n = 211) Variables Mean ± SD/ n (%) Min-Max Age 50,43 ± 29,269 0–98 n (211) % Gender Female 79 37,4 Male 132 62,6 Age 81 24 11,4 Klinik Emergency 54 25,6 Surgical Clinics 24 11,4 Internal Medicine Clinics 91 43,1 Other 2 0,9 Pediatric Clinics 40 19 Location of Fall Clinic/Patient Room 150 71,1 Examination/ Intervention Room 31 14,7 Corridor 5 2,4 Bathroom/toilet 25 11,8 Fall Risk Score Low 16 7,6 High 195 92,4 Causes of Falls Patient - Related 126 59,7 Caregiver - related 70 33,2 Equipment - related 10 4,7 Environment - related 3 1,4 Staff - related 1 0,5 Document - related 1 0,5 Additional Diagnostic Tests After Fall No 196 92,9 Yes 15 7,1 Fall Rate (per 1000 patients) 2020 31 0,014 2021 22 0,008 2022 44 0,015 2023 36 0,011 2024 78 0,023 During the five-year study period, the distribution of patient falls by age and gender revealed that the highest number of falls occurred among male patients aged 65–80 years, followed by those in the 36–64 age group, and thirdly among children under the age of five (Fig. 2 ). When the distribution of fall risk scores (low–high) was examined by age group, the majority of patients were identified as being in the high-risk category, predominantly within the 65–80 age group (Fig. 3 ). The association between gender and fall risk was analyzed using the Pearson chi-square test, and no statistically significant relationship was found (p = 0.194). Table 2 Analysis of the relationship between age and fall risk Age Low High p 81 0 24 The analysis of fall risk scores by age group demonstrated that the majority of patients across all age categories were classified as high risk. Specifically, in the 65–80 age group, 61 patients were identified as high risk compared to only 3 as low risk, while in patients older than 81 years, all cases (n = 24) were classified as high risk. Similarly, in the 36–64 age group, 57 patients were at high risk and only 7 at low risk. Among children under 5 years of age, 42 were categorized as high risk compared to 4 at low risk, whereas in the 6–17 age group, 2 patients were at high risk and 1 at low risk. The 18–35 age group also showed a predominance of high-risk cases (n = 9) compared to low-risk (n = 1). Statistical analysis using the Pearson Chi-Square test revealed no significant association between age and fall risk (p = .239). Despite the lack of statistical significance, the distribution indicates that older patients, particularly those aged 65 years and above, were more frequently classified as high risk, consistent with the literature highlighting advanced age as a major factor contributing to in-hospital falls (Table 2 ). A root cause analysis was performed for patient falls during the study period. Based on the analysis, the causes of falls were classified into six main categories: patient-related, caregiver-related, equipment-related, environment-related, staff-related, and procedure-related factors. The findings are summarized as follows: Patient-related factors included agitation or anxiety, impaired consciousness, dizziness, loss of balance due to absence of a caregiver, attempts to sit or lie down independently, efforts to avoid disturbing their caregiver, parental attempts to sleep next to or rock their infant/child, wearing inappropriate slippers, orthostatic hypotension, hypoglycemia, polypharmacy, imbalance due to inability to use one leg, noncompliance with instructions, leaving the bed without permission, lowering bedrails independently, muscle weakness due to hemiplegia, and slipping of mobility aids. Caregiver-related factors involved failure to comply with fall prevention measures, leaving the patient unattended without notifying nursing staff, absence of a caregiver, inadequate implementation of safety measures, allowing the patient to mobilize alone, distraction or negligence, falling asleep while holding a baby, not locking wheelchair brakes, and independently lowering bedrails or stretcher rails. Equipment-related factors included unsuitable stretchers, rapid wear and tear of bed or stretcher side rails, and use of inappropriate slippers. Environment-related factors included inadequate lighting (e.g., room lights turned off), absence of wet floor warnings, and improper use of handrails. Staff-related factors involved being occupied with emergencies or caring for other patients, as well as errors in fall risk assessment. Procedure-related factors included procedural errors and improper implementation of existing protocols. The root cause analysis is presented in Fig. 4 . Discussion Patient safety aims to create a secure environment in which potential adverse events such as falls, medication errors, and infections are systematically evaluated [ 31 ]. In this context, the prevention of inpatient falls is of vital importance for ensuring the integrity of diagnostic and therapeutic processes [ 32 ]. Falls occurring in hospital settings are considered a critical indicator of patient safety [ 33 ]. Conducting root cause analysis (RCA) of patient falls is essential to identify their underlying causes and to implement preventive action plans [ 31 ]. In this study, root cause analysis of inpatient falls reported over a five-year period in a tertiary training and research hospital was conducted and evaluated. Although fall prevention interventions are effective, they require resources and should specifically target individuals at higher risk [ 21 ]. Efforts to reduce inpatient falls and their associated costs should prioritize patient engagement, education, and evidence-based interventions [ 34 ]. Hospital falls significantly prolong the length of stay (LOS), with reports indicating an additional 6 to 12 days of hospitalization following a fall [ 34 ] [ 35 ]. Similarly, falls have been associated with an average extension of 6.3 days in LOS [ 32 ]. Cognitive status plays a crucial role in increasing the likelihood of falls. A meta-analysis investigating hospital falls reported that 36.3% of patients who experienced falls presented with cognitive impairment [ 34 ]. Prominent risk factors for inpatient falls include advanced age (> 85 years), male sex, fall history, gait instability, visual impairment, agitation and/or confusion, adverse drug reactions, neurological and cardiovascular instability, orthostatic hypotension, and pharmacological agents such as antihypertensives and diuretics [ 32 ].[ 34 ].[ 19 ].[ 36 ]. Previous studies have indicated that approximately 12% of hospitalized patients experience at least one fall during their stay [ 6 ]. Reported incidence rates vary, ranging from 2.4 per 1000 patient-days in tertiary hospitals to 9.1 per 1000 patient-days in geriatric units. Older adults with cognitive impairment are particularly vulnerable to falls [ 32 ]. Elderly people with cognitive impairment are more likely to slip and fall, which is a significant risk factor for falls [ 37 ]. According to Xu et al. (2022), factors such as advanced age, low educational level, polypharmacy, malnutrition, living alone, urban residency, smoking, and alcohol consumption increase the likelihood of falls in older adults. Additionally, comorbidities including cardiovascular disease, hypertension, diabetes, stroke, weakness, depression, Parkinson’s disease, and chronic pain are known contributors to fall risk [ 16 ][ 34 ]. Studies have also examined the activities during which falls occur, such as attempting to sit, stand, bend, get out of bed, use the bathroom without assistance, or walk unassisted. Frequently reported locations of falls include bathrooms, patient rooms, treatment areas, hallways, and common hospital spaces [ 38 ]. The first step in fall prevention is the identification of high-risk patients and the implementation of targeted risk-reduction programs [ 32 ]. A non-punitive, supportive reporting culture is critical to ensure accurate reporting. Hospital administrators should adopt a visionary, non-punitive approach to promote confidence in reporting systems [ 1 ]. Underreporting remains a major issue, with estimates suggesting that approximately 40% of inpatient falls are not reported. In one study, nearly 75% of nurses in a tertiary hospital considered incident reporting systems unsafe [ 23 ] The root causes of hospital falls are often multifactorial, including patient-related factors (37.5%), environmental conditions (25%), organizational and process-related issues (19.6%), and staff communication problems (17.9%) [ 31 ]. Similarly, Cesar et al. (2025) reported that 76% of falls resulted from internal factors, while 21% were attributable to external causes [ 33 ]. Strategies for fall prevention include environmental modifications and physical safeguards (29.4%), risk assessment and monitoring (23.5%), patient and staff education (21.6%), standardized fall risk assessment tools (13.7%), and auditing and monitoring practices (11.8%) [ 31 ]. Evidence-based measures such as ensuring locked bed brakes, lowering bed height, providing bedside commodes, assisting patients during toileting, and hourly rounding have been identified as effective fall prevention strategies. However, qualitative studies have emphasized barriers including inconsistencies in guidelines, lack of patient awareness regarding fall risks, and inadequate interprofessional communication [ 34 ]. The consequences of inpatient falls include both physical and clinical outcomes. Approximately 59.2% of falls result in injuries, most commonly head injuries (49%). While some patients remain clinically stable post-fall, up to 20.4% experience instability [ 39 ]. Additional investigations, such as radiological imaging, are often required, [ 33 ]. Falls are frequently linked to inadequate patient/family education, insufficient supervision, lack of communication between nurses and patients, ineffective use of call bells, and poor adherence to fall prevention guidelines. Multicomponent interventions that incorporate patient and caregiver training, environmental modifications, and nursing supervision have been shown to reduce fall rates [ 15 ]. Nurses play a pivotal role in the early identification and prevention of falls due to their continuous patient interaction [ 40 ]. As the frontline of patient care, nurses are essential in empowering patients and families with knowledge about fall prevention strategies such as using call bells, wearing safe footwear, utilizing assistive devices, and seeking help during mobilization [ 41 ]. While falls cannot be completely eliminated, effective nursing interventions can substantially minimize fall risks and adverse outcomes [ 40 ]. Conclusion In conclusion, falls represent a serious clinical problem among hospitalized patients, particularly older adults who face an increased risk of injury due to multiple contributing factors. Preventing inpatient falls requires a holistic approach that takes into account all potential risk factors. Falls in hospitalized patients are complex yet preventable adverse events that may result in patient harm, negatively affect clinical outcomes, and increase healthcare costs. Key risk factors for falls include advanced age, cognitive impairment, polypharmacy, and comorbid medical conditions. Identifying and addressing these factors are critical steps toward preventing falls and ensuring patient safety in healthcare settings. Furthermore, demographic characteristics, comorbidities, and lifestyle factors should be carefully considered when assessing fall risk. Abbreviations WHO (Worl Health Organizations) HQS (Healthcare Quality Standards) LOS (length of Stay) RCA (Root cause analysis) SPSS (Statistical Package for the Social Sciences) SD (Standart Deviation) Declarations Acknowledgements The present document is the original work of the authors. Special thanks to Antalya Training and Research Hospital's authorities for their permission for this study. Author contributions The authors contributed as follows. Substantial contributions to the conception or design of the work: H.E.K., and N.Ö. Contributed to the acquisition, analysis, or interpretation of data for the work: All authors. Drafting or revising the work critically for important intellectual content: All authors. Final approval of the version to be published: All authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors. Clinical trial number: not applicable Funding This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors. Data availability The data from the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate . Ethical approval (Approval No: 2025/188, dated 19.06.2025) for this study was obtained from the Antalya Training and Research Hospital Ethical Committee, Antalya, Türkiye. The research team exclusively managed all the data collected, adhering to appropriate human research ethics guidelines. The study adhered to the Declaration of Helsinki, and all participants provided informed consent upon enrollment. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Research Development Department, Antalya Training and Research Hospital, Antalya, Türkiye 2 Research and Development Department, Antalya Training and Research Hospital, Antalya, Türkiye References Bhati D, Deogade MS, Kanyal D. Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review. Cureus. 2023;15(10). 10.7759/cureus.47731 . Kiliç Ü, Özaydin Ö, Güdük Ö, Okut G. 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Cite Share Download PDF Status: Published Journal Publication published 28 Jan, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 17 Dec, 2025 Reviews received at journal 16 Dec, 2025 Reviewers agreed at journal 05 Dec, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers invited by journal 01 Oct, 2025 Editor invited by journal 29 Sep, 2025 Editor assigned by journal 19 Sep, 2025 Submission checks completed at journal 18 Sep, 2025 First submitted to journal 18 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7579750","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528058988,"identity":"2c3710fc-872e-415b-b59b-d8b9bc71e3fe","order_by":0,"name":"Hatice ESEN","email":"","orcid":"","institution":"Antalya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hatice","middleName":"","lastName":"ESEN","suffix":""},{"id":528058989,"identity":"f9d673e3-2844-4089-b9a7-2e2636407e30","order_by":1,"name":"Nazife ÖZTÜRK","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIie3PMWrDMBSAYRmBs7wD6BgJBbUFYR2ki4JAnrJn8KAuzeIDJIfo2vkZQbqYejVkqQlkdrdMpVJDp2K73QrVP1hg3qeHCInF/mi4vpyU9Gfhz+QeJ0ntP+BJsitNIHaSkC9CIXWXS8amr2fPHeJaSMlWx8UWmuxx4/yWQtwNkdtSKcTaUGD5lepvDvqpXnqyNys7QOao0L09uBSYodUWDpqjJ4l1w6TpLFbvDgJxkL5oHv6MklYTrKxjgWhIMePt1Jb2RBD3Zg71iS52pVa89VvU2Fua/NhjIeRsYyjrz5nkTd699oUYJN9afk6qn46H5G+GY7FY7H/0Aa6NaF9a69pBAAAAAElFTkSuQmCC","orcid":"","institution":"Antalya Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Nazife","middleName":"","lastName":"ÖZTÜRK","suffix":""}],"badges":[],"createdAt":"2025-09-10 07:08:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7579750/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7579750/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-026-14084-2","type":"published","date":"2026-01-28T15:58:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93573530,"identity":"cdbe6345-7e30-4f26-80f4-4c6b8f01f3f0","added_by":"auto","created_at":"2025-10-15 09:11:50","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":412576,"visible":true,"origin":"","legend":"","description":"","filename":"manuscuriptpatientfallrevised2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/7fec0bd978345b68a9e44cdc.docx"},{"id":93573534,"identity":"f74ab6cb-82c0-4178-847f-c88752b93a7c","added_by":"auto","created_at":"2025-10-15 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09:11:50","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99111,"visible":true,"origin":"","legend":"","description":"","filename":"36ed7965896a45bf9b4c388f194a8ed91structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/ddff3137bfb0e246d781a5c3.xml"},{"id":93573537,"identity":"05957e03-23a6-4946-9817-6eddd47c9074","added_by":"auto","created_at":"2025-10-15 09:11:50","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109976,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/fe3ae8fa1622f9f60de4b77f.html"},{"id":93573525,"identity":"7d9e71d9-2eed-4324-a18f-096d5ebbe404","added_by":"auto","created_at":"2025-10-15 09:11:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32648,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of the number of falls by year\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/1eeb01f00d2cb39ff7250a97.png"},{"id":93573536,"identity":"832383ce-a37a-46d2-8b8e-ddf7d80800d2","added_by":"auto","created_at":"2025-10-15 09:11:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33096,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGender distribution by age group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/b73c7f30ecc06202f7220606.png"},{"id":93573526,"identity":"fe1aaee6-7a9b-4824-9128-365ebcf61abf","added_by":"auto","created_at":"2025-10-15 09:11:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37377,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of fall risk (Low/High) by age group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/a93d58e31aed4e6952b7590c.png"},{"id":93574883,"identity":"7c2493a7-2e65-414d-afd2-8d7e57907368","added_by":"auto","created_at":"2025-10-15 09:19:50","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":275706,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRoot Cause Analysis of Patient Falls\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/506ee0ce6a453368378b492d.png"},{"id":101690492,"identity":"d47a5b61-8c32-4622-95f1-b42766895ddd","added_by":"auto","created_at":"2026-02-02 16:04:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1129724,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7579750/v1/56392df2-a268-457e-ac00-02ddc87023fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Five-Year Retrospective Study of Patient Falls in a Tertiary Hospital: Monitoring, Causes, and Impact on Patient Safety and Quality of Care","fulltext":[{"header":"Highlights","content":"\u003cp\u003e- This study presents a five-year root cause analysis of inpatient falls in a tertiary training and research hospital.\u003c/p\u003e\u003cp\u003e- The majority of falls occurred among high-risk patients aged 65\u0026ndash;80 years and in male patients, with most events reported in patient rooms.\u003c/p\u003e\u003cp\u003e- Patient-related factors, including cognitive impairment, polypharmacy, and lack of compliance with preventive measures, were identified as the primary causes of falls.\u003c/p\u003e\u003cp\u003e- Despite preventive protocols, underreporting and insufficient patient/caregiver engagement remain critical challenges in fall prevention.\u003c/p\u003e\u003cp\u003e- Findings emphasize the importance of systematic risk assessment, patient and caregiver education, and evidence-based fall prevention strategies to strengthen patient safety culture.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eHospitals serve as the cornerstone of healthcare institutions, playing a central role in the health ecosystem by providing uninterrupted healthcare services [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Ensuring patient safety is the foremost priority for achieving high-quality, effective, and safe patient care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The World Health Organization (WHO) defines patient safety as the absence of preventable harm to a patient during the process of healthcare [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Patient safety has become the most important priority for hospitals, with efforts directed toward establishing safer care environments where major complications are reduced [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Consequently, quality improvement practices and patient safety initiatives have emerged as fundamental goals of hospital management, making the implementation of specific preventive measures essential to achieving these objectives [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHospital falls are among the most common and preventable patient safety incidents worldwide. A fall is defined as an unintentional descent to a lower level, regardless of whether an injury occurs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Falls represent a major global safety concern. The WHO reports that approximately 37.3\u0026nbsp;million falls each year require medical attention, and around 684,000 people die annually due to falls [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e][\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Notably, the incidence of falls increases with age, with one in three adults aged 65 years and older experiencing at least one fall annually [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, approximately 600,000 fall-related deaths occur worldwide each year, making falls one of the leading causes of traumatic mortality [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Falls are also recognized as a leading cause of preventable injuries [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To reduce this risk, the WHO recommends creating safer environments, enhancing community education, increasing fall-related research, and developing appropriate prevention policies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe causes of hospital falls are multifactorial, involving patient characteristics, caregivers, environmental factors, medications, and deficiencies in care processes, all of which can contribute to an increased risk [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, the use of risk assessment tools, the development of preventive protocols, and the implementation of root cause analyses are essential strategies to improve patient safety in clinical settings [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNurses play a central role in fall-prevention strategies, and effective nursing practices have been shown to directly reduce the incidence of falls [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Most research to date has focused on identifying fall risks within the framework of global imperatives for prevention and management; however, interventions and preventive strategies for falls have not yet provided a universally accepted gold standard [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In this context, identifying the frequency, causes, and risk factors of hospital falls is essential to guide the development of effective fall-prevention programs. This study aimed to examine the frequency and characteristics of inpatient falls over a five-year period and to identify their underlying causes through root cause analysis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis research was conducted as a descriptive study using retrospective data.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSetting and Sample\u003c/h3\u003e\n\u003cp\u003eThe study was carried out in a tertiary-level training and research hospital located in Antalya, T\u0026uuml;rkiye.\u003c/p\u003e\n\u003ch3\u003eFall Risk Assessment Tools\u003c/h3\u003e\n\u003cp\u003eIdentifying potential risk factors that may lead to patient falls during hospitalization is of critical importance [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. According to the Turkish Ministry of Health\u0026rsquo;s Healthcare Quality Standards (HQS), risk assessments must be performed, fall incidents should be monitored, preventive measures should be implemented at patient, ward, and hospital levels, and outcomes should be followed using quality indicators [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Within this framework, the Itaki Fall Risk Scale is used for adult patients, while the Harizmi Fall Risk Scale is applied to pediatric patients. The Itaki Fall Risk Scale evaluates 19 risk factors categorized as major or minor, and classifies patients into two groups: low risk and high risk [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e][\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In this study, the risk levels derived from the Itaki Scale (low vs. high) were used for analysis.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were retrospectively obtained from patient records covering the years 2020\u0026ndash;2024. Information was collected using the \u0026ldquo;Patient Fall Data Collection Form\u0026rdquo; and the \u0026ldquo;Patient Fall Data Analysis Form,\u0026rdquo; which are implemented under the HQS framework of the Ministry of Health. Over the five-year period, data from 211 inpatients who experienced a fall during hospitalization were included in the study.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePatient Fall Data Collection Form\u003c/b\u003e: includes patient name, age, gender, diagnosis, clinical unit, fall location, fall risk score, cause of fall, and pre-/post-fall patient status.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePatient Fall Data Analysis Form\u003c/b\u003e: a mandatory hospital reporting tool completed monthly, which documents the number of hospitalized patients, number of falls, fall rates, locations of falls, and distribution of risk scores. The fall rate was calculated using the following formula defined by the Ministry of Health [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]:\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNumber of patient falls\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cimg 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\" width=\"541\" height=\"133\"\u003e\u003c/p\u003e\u003cp\u003eData were analyzed using Statistical Package for the Social Sciences (SPSS) Statistics version 22. Descriptive statistics included means, standard deviations, and frequency distributions. Group differences were examined using Chi-square tests, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThis study was approved by Antalya Traning and Research Hospital Ethics Committee (Approval No: 2025/188, dated 19.06.2025) and conducted in accordance with the Declaration of Helsinki. This study used retrospective, anonymized patient safety data. No direct patient contact was involved. The requirement for individual informed consent was waived by the Ethics Committee.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study was conducted in a single center, which limits the generalizability of the findings to the national level.\u003c/p\u003e\u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eDuring the five-year study period, a total of 211 inpatient falls were reported as adverse events. The lowest number of falls was observed in 2021 (n\u0026thinsp;=\u0026thinsp;22), while the highest was recorded in 2024 (n\u0026thinsp;=\u0026thinsp;78), indicating an upward trend over the years (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eDuring the five-year study period, a total of 211 inpatient falls were reported as adverse events. The lowest number of falls was observed in 2021 (n\u0026thinsp;=\u0026thinsp;22), while the highest was recorded in 2024 (n\u0026thinsp;=\u0026thinsp;78), indicating an upward trend over the years (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe mean age of patients who experienced a fall was 50.43\u0026thinsp;\u0026plusmn;\u0026thinsp;29.27 years, with the majority being male (62.6%). Falls were most frequently observed among patients in the 36\u0026ndash;80 years age group (60.6%). The highest proportion of falls occurred in internal medicine clinics (43.1%), and according to the Itaki Fall Risk Scale, 92.4% of patients were classified as being at high risk for falls.\u003c/p\u003e\u003cp\u003eIn terms of fall locations, the majority occurred in patient rooms (71.1%), followed by procedure/examination rooms (14.7%) and bathrooms/toilets (11.8%). The overall inpatient fall rate across the years was approximately 0.01%.\u003c/p\u003e\u003cp\u003eRoot cause evaluation indicated that most falls (59.7%) were due to patient-related factors. Following the incidents, the majority of patients did not require additional diagnostic investigations (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Patients Who Experienced Falls (n\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD/ n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMin-Max\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e50,43\u0026thinsp;\u0026plusmn;\u0026thinsp;29,269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u0026ndash;98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (211)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e37,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e62,6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e21,8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e30,3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u0026ndash;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e30,3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e11,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKlinik\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e25,6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical Clinics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e11,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine Clinics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e43,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePediatric Clinics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eLocation of Fall\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinic/Patient Room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e71,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExamination/ Intervention Room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e14,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorridor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBathroom/toilet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e11,8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFall Risk Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e7,6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e92,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eCauses of Falls\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient - Related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e59,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver - related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e33,2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEquipment - related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4,7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnvironment - related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1,4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff - related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDocument - related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAdditional Diagnostic Tests After Fall\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e92,9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e7,1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eFall Rate (per 1000 patients)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0,023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDuring the five-year study period, the distribution of patient falls by age and gender revealed that the highest number of falls occurred among male patients aged 65\u0026ndash;80 years, followed by those in the 36\u0026ndash;64 age group, and thirdly among children under the age of five (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWhen the distribution of fall risk scores (low\u0026ndash;high) was examined by age group, the majority of patients were identified as being in the high-risk category, predominantly within the 65\u0026ndash;80 age group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe association between gender and fall risk was analyzed using the Pearson chi-square test, and no statistically significant relationship was found (p\u0026thinsp;=\u0026thinsp;0.194).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of the relationship between age and fall risk\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 yaş\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e.239\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;17 yaş\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;35 yaş\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;64 yaş\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65\u0026ndash;80 yaş\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe analysis of fall risk scores by age group demonstrated that the majority of patients across all age categories were classified as high risk. Specifically, in the 65\u0026ndash;80 age group, 61 patients were identified as high risk compared to only 3 as low risk, while in patients older than 81 years, all cases (n\u0026thinsp;=\u0026thinsp;24) were classified as high risk. Similarly, in the 36\u0026ndash;64 age group, 57 patients were at high risk and only 7 at low risk. Among children under 5 years of age, 42 were categorized as high risk compared to 4 at low risk, whereas in the 6\u0026ndash;17 age group, 2 patients were at high risk and 1 at low risk. The 18\u0026ndash;35 age group also showed a predominance of high-risk cases (n\u0026thinsp;=\u0026thinsp;9) compared to low-risk (n\u0026thinsp;=\u0026thinsp;1). Statistical analysis using the Pearson Chi-Square test revealed no significant association between age and fall risk (p\u0026thinsp;=\u0026thinsp;.239). Despite the lack of statistical significance, the distribution indicates that older patients, particularly those aged 65 years and above, were more frequently classified as high risk, consistent with the literature highlighting advanced age as a major factor contributing to in-hospital falls (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA root cause analysis was performed for patient falls during the study period. Based on the analysis, the causes of falls were classified into six main categories: patient-related, caregiver-related, equipment-related, environment-related, staff-related, and procedure-related factors. The findings are summarized as follows:\u003c/p\u003e\u003cp\u003ePatient-related factors included agitation or anxiety, impaired consciousness, dizziness, loss of balance due to absence of a caregiver, attempts to sit or lie down independently, efforts to avoid disturbing their caregiver, parental attempts to sleep next to or rock their infant/child, wearing inappropriate slippers, orthostatic hypotension, hypoglycemia, polypharmacy, imbalance due to inability to use one leg, noncompliance with instructions, leaving the bed without permission, lowering bedrails independently, muscle weakness due to hemiplegia, and slipping of mobility aids.\u003c/p\u003e\u003cp\u003eCaregiver-related factors involved failure to comply with fall prevention measures, leaving the patient unattended without notifying nursing staff, absence of a caregiver, inadequate implementation of safety measures, allowing the patient to mobilize alone, distraction or negligence, falling asleep while holding a baby, not locking wheelchair brakes, and independently lowering bedrails or stretcher rails.\u003c/p\u003e\u003cp\u003eEquipment-related factors included unsuitable stretchers, rapid wear and tear of bed or stretcher side rails, and use of inappropriate slippers. Environment-related factors included inadequate lighting (e.g., room lights turned off), absence of wet floor warnings, and improper use of handrails. Staff-related factors involved being occupied with emergencies or caring for other patients, as well as errors in fall risk assessment. Procedure-related factors included procedural errors and improper implementation of existing protocols.\u003c/p\u003e\u003cp\u003eThe root cause analysis is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatient safety aims to create a secure environment in which potential adverse events such as falls, medication errors, and infections are systematically evaluated [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In this context, the prevention of inpatient falls is of vital importance for ensuring the integrity of diagnostic and therapeutic processes [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Falls occurring in hospital settings are considered a critical indicator of patient safety [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Conducting root cause analysis (RCA) of patient falls is essential to identify their underlying causes and to implement preventive action plans [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In this study, root cause analysis of inpatient falls reported over a five-year period in a tertiary training and research hospital was conducted and evaluated.\u003c/p\u003e\u003cp\u003eAlthough fall prevention interventions are effective, they require resources and should specifically target individuals at higher risk [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Efforts to reduce inpatient falls and their associated costs should prioritize patient engagement, education, and evidence-based interventions [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Hospital falls significantly prolong the length of stay (LOS), with reports indicating an additional 6 to 12 days of hospitalization following a fall [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Similarly, falls have been associated with an average extension of 6.3 days in LOS [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCognitive status plays a crucial role in increasing the likelihood of falls. A meta-analysis investigating hospital falls reported that 36.3% of patients who experienced falls presented with cognitive impairment [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Prominent risk factors for inpatient falls include advanced age (\u0026gt;\u0026thinsp;85 years), male sex, fall history, gait instability, visual impairment, agitation and/or confusion, adverse drug reactions, neurological and cardiovascular instability, orthostatic hypotension, and pharmacological agents such as antihypertensives and diuretics [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Previous studies have indicated that approximately 12% of hospitalized patients experience at least one fall during their stay [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Reported incidence rates vary, ranging from 2.4 per 1000 patient-days in tertiary hospitals to 9.1 per 1000 patient-days in geriatric units. Older adults with cognitive impairment are particularly vulnerable to falls [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Elderly people with cognitive impairment are more likely to slip and fall, which is a significant risk factor for falls [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to Xu et al. (2022), factors such as advanced age, low educational level, polypharmacy, malnutrition, living alone, urban residency, smoking, and alcohol consumption increase the likelihood of falls in older adults. Additionally, comorbidities including cardiovascular disease, hypertension, diabetes, stroke, weakness, depression, Parkinson\u0026rsquo;s disease, and chronic pain are known contributors to fall risk [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Studies have also examined the activities during which falls occur, such as attempting to sit, stand, bend, get out of bed, use the bathroom without assistance, or walk unassisted. Frequently reported locations of falls include bathrooms, patient rooms, treatment areas, hallways, and common hospital spaces [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe first step in fall prevention is the identification of high-risk patients and the implementation of targeted risk-reduction programs [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA non-punitive, supportive reporting culture is critical to ensure accurate reporting. Hospital administrators should adopt a visionary, non-punitive approach to promote confidence in reporting systems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Underreporting remains a major issue, with estimates suggesting that approximately 40% of inpatient falls are not reported. In one study, nearly 75% of nurses in a tertiary hospital considered incident reporting systems unsafe [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe root causes of hospital falls are often multifactorial, including patient-related factors (37.5%), environmental conditions (25%), organizational and process-related issues (19.6%), and staff communication problems (17.9%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similarly, Cesar et al. (2025) reported that 76% of falls resulted from internal factors, while 21% were attributable to external causes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Strategies for fall prevention include environmental modifications and physical safeguards (29.4%), risk assessment and monitoring (23.5%), patient and staff education (21.6%), standardized fall risk assessment tools (13.7%), and auditing and monitoring practices (11.8%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Evidence-based measures such as ensuring locked bed brakes, lowering bed height, providing bedside commodes, assisting patients during toileting, and hourly rounding have been identified as effective fall prevention strategies. However, qualitative studies have emphasized barriers including inconsistencies in guidelines, lack of patient awareness regarding fall risks, and inadequate interprofessional communication [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe consequences of inpatient falls include both physical and clinical outcomes. Approximately 59.2% of falls result in injuries, most commonly head injuries (49%). While some patients remain clinically stable post-fall, up to 20.4% experience instability [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Additional investigations, such as radiological imaging, are often required, [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFalls are frequently linked to inadequate patient/family education, insufficient supervision, lack of communication between nurses and patients, ineffective use of call bells, and poor adherence to fall prevention guidelines. Multicomponent interventions that incorporate patient and caregiver training, environmental modifications, and nursing supervision have been shown to reduce fall rates [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNurses play a pivotal role in the early identification and prevention of falls due to their continuous patient interaction [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. As the frontline of patient care, nurses are essential in empowering patients and families with knowledge about fall prevention strategies such as using call bells, wearing safe footwear, utilizing assistive devices, and seeking help during mobilization [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. While falls cannot be completely eliminated, effective nursing interventions can substantially minimize fall risks and adverse outcomes [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, falls represent a serious clinical problem among hospitalized patients, particularly older adults who face an increased risk of injury due to multiple contributing factors. Preventing inpatient falls requires a holistic approach that takes into account all potential risk factors. Falls in hospitalized patients are complex yet preventable adverse events that may result in patient harm, negatively affect clinical outcomes, and increase healthcare costs.\u003c/p\u003e\u003cp\u003eKey risk factors for falls include advanced age, cognitive impairment, polypharmacy, and comorbid medical conditions. Identifying and addressing these factors are critical steps toward preventing falls and ensuring patient safety in healthcare settings. Furthermore, demographic characteristics, comorbidities, and lifestyle factors should be carefully considered when assessing fall risk.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eWHO\u0026nbsp;\u003c/strong\u003e(Worl Health Organizations)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHQS\u003c/strong\u003e (Healthcare Quality Standards)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLOS\u0026nbsp;\u003c/strong\u003e(length of Stay)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRCA\u003c/strong\u003e (Root cause analysis)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e (Statistical Package for the Social Sciences)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e (Standart Deviation)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present document is the original work of the authors. Special thanks to Antalya Training and Research Hospital\u0026apos;s authorities for their permission for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors contributed as follows. Substantial contributions to the conception or design of the work: H.E.K., and N.\u0026Ouml;. Contributed to the acquisition, analysis, or interpretation of data for the work: All authors. Drafting or revising the work critically for important intellectual content: All authors. Final approval of the version to be published: All authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data from the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval (Approval No: 2025/188, dated 19.06.2025) for this study was obtained from the Antalya Training and Research Hospital Ethical Committee, Antalya, T\u0026uuml;rkiye. The research team exclusively managed all the data collected, adhering to appropriate human research ethics guidelines. The study adhered to the Declaration of Helsinki, and all participants provided informed consent upon enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eResearch Development Department, Antalya Training and Research Hospital, Antalya, T\u0026uuml;rkiye\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eResearch and Development Department, Antalya Training and Research Hospital, Antalya, T\u0026uuml;rkiye\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBhati D, Deogade MS, Kanyal D. 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March, pp. 1\u0026ndash;9, 2021, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2021.592440\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2021.592440\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Falls in hospitals, patient falls, patient safety, root and cause analysis","lastPublishedDoi":"10.21203/rs.3.rs-7579750/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7579750/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFalls in hospitalized patients are among the most common preventable adverse events and pose a major threat to patient safety. Despite preventive protocols, falls remain frequent and are associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Understanding the frequency, characteristics, and root causes of falls is essential to improve patient safety strategies.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThis study aimed to examine the frequency and characteristics of inpatient falls over a five-year period and to identify their underlying causes through root cause analysis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective descriptive study was conducted using hospital adverse event notification records between 2020 and 2024. A total of 211 fall incidents were identified and analyzed in terms of demographic characteristics, clinical settings, fall locations, risk scores, and root causes. The Itaki Fall Risk Scale was used to assess patient risk levels, and contributing factors were categorized into patient-related, caregiver-related, equipment-related, environmental, staff-related, and procedural causes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the 211 reported falls, the mean patient age was 50.4\u0026thinsp;\u0026plusmn;\u0026thinsp;29.3 years, and most cases involved male patients (62.6%). The highest fall incidence was observed in 2024 (n\u0026thinsp;=\u0026thinsp;78), indicating an increasing trend across the years. The majority of patients (92.4%) were classified as high risk according to the Itaki Fall Risk Scale. Most falls occurred in patient rooms (71.1%), followed by procedure/examination rooms (14.7%) and bathrooms/toilets (11.8%). Root cause analysis revealed that falls were primarily patient-related (59.7%), followed by caregiver-, equipment-, environmental-, staff-, and procedure-related factors.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePatient falls remain a significant safety concern in hospitals, with most cases occurring among high-risk patients and being preventable. Root cause analysis highlights the multifactorial nature of falls, emphasizing the need for comprehensive preventive strategies that address patient behavior, caregiver awareness, environmental safety, and staff compliance with protocols. Strengthening fall prevention programs is crucial to improving patient safety and reducing healthcare costs.\u003c/p\u003e","manuscriptTitle":"A Five-Year Retrospective Study of Patient Falls in a Tertiary Hospital: Monitoring, Causes, and Impact on Patient Safety and Quality of Care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 09:11:45","doi":"10.21203/rs.3.rs-7579750/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-17T09:55:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T14:55:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250321595826601540356323750644463937506","date":"2025-12-06T00:12:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T19:57:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139981870216060496466212972391603710610","date":"2025-10-01T11:32:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-01T11:11:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-29T09:55:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-19T08:50:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-18T15:22:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-18T14:13:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1d476d5-8035-4bbd-b8e0-87fd45deccb5","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:01:18+00:00","versionOfRecord":{"articleIdentity":"rs-7579750","link":"https://doi.org/10.1186/s12913-026-14084-2","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-01-28 15:58:43","publishedOnDateReadable":"January 28th, 2026"},"versionCreatedAt":"2025-10-15 09:11:45","video":"","vorDoi":"10.1186/s12913-026-14084-2","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14084-2","workflowStages":[]},"version":"v1","identity":"rs-7579750","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7579750","identity":"rs-7579750","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}