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Which patient safety missteps add to hospitals' fall rates?

Most patient falls occur during patient transfers and in acute care settings, leaving experts to advise a strong emphasis on a systems-level patient safety culture.

Sara Heath
By
Published: 28 May 2026

Falls are a key measure of patient safety, affecting hundreds of thousands of patients in the U.S. each year. In a new analysis from ECRI, researchers say better reporting workflows and health system processes could help organizations predict and prevent falls.

The report leveraged data about 8 million patient safety events submitted by healthcare providers nationwide. In an examination of 71,456 falls in 2025, the researchers identified factors associated with patient falls, including when they happen, who's most at risk and which facilities see the highest fall rates.

Overall, the data indicated that falls happen when there's a health system failure, not a human failure, and that warrants a better look, according to Shannon Kooker, vice president of Clinical Experience and Patient Safety at ECRI.

"Falls are often viewed as isolated incidents, but the data consistently show that they are deeply connected to how care systems function," Kooker said in a press release. "Many falls occur during routine care activities that require coordination between caregivers, so we should be focusing on the systems surrounding patient movement and handoffs, not simply on individual patient or staff behavior."

Breaking down patient fall trends in the U.S.

According to the Agency for Healthcare Research and Quality, falls affect between 700,000 and a million people in the U.S. every year.

Based on ECRI's 70,000-fall sample, the majority of these incidents (68.1%) are happening in acute care settings. However, it's not unheard of for them to happen in post-acute care settings such as nursing homes, rehabilitation centers or even home healthcare and behavioral health settings.

Most of the time, falls happen when a patient is being moved. About 85% of these falls happen during patient transfers, toileting or ambulation.

Transfers refer to moves between surfaces, such as from the bed to a wheelchair. Ambulation refers to general movement around the care environment with or without assistance, such as within the hospital room or hallway.

Falls during transfers were the most common, accounting for 45.3% of all falls, followed by toileting, which accounts for 30.7% of falls. Falls during ambulation accounted for 9.4% of falls.

Falls can happen to anyone, the analysis continued, challenging the misconception that they are mostly concentrated among older adults. Indeed, 30% of all hospital falls happen among those ages 18-64, the most common age cohort in the fall analysis.

This means fall prevention efforts can't just focus on a single age group, but rather account for all patients, ECRI stressed.

Patient safety reporting key to preventing falls

According to ECRI, patient safety reporting will be integral to reducing the nation's patient fall rate.

Notably, 9,000 of the falls the organization analyzed were noted as "near-misses," meaning they did not result in patient harm or unsafe conditions. ECRI said this indicates that more organizations are enabling patient safety reporting, which in turn lets them examine the conditions that could have led to patient harm and prevent the issue from snowballing.

In particular, organizations assessing fall event data should use that information to flag operational vulnerabilities and workflow gaps. Likewise, identifying risks during patient movement -- such as during care transitions and toileting -- will be integral.

Finally, ECRI stressed the importance of human-centered design when implementing hospital protocol. Although staff training, signage and patient safety technology are important, they will not be effective if a hospital's systems do not allow staff to promote patient safety.

"Fall prevention requires more than alarms or checklists; it requires understanding how care is actually delivered and experienced in real clinical environments," Polly Tremoulet, director of Human Factors Engineering at ECRI, said in the press release.

"When we apply human factors-based systems thinking after a fall or near-miss, we seek to understand how system design influences patient safety and identify ways to redesign care environments to better meet the needs of both staff and patients -- from reconfiguring room layouts to ensuring practical tools like non-slip socks are consistently available."

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.

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