Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Alan Salmoni

2nd Supervisor

Aleksandra Zecevic

Joint Supervisor



Falls are frequent and often serious events that take place in hospitals. Healthcare providers find it challenging to minimize fall risk factors. In fact, just being in a hospital is a risk factor in itself! The aim of this thesis was to investigate the reasons behind patient falls, identify gaps in prevention strategies and suggest additional recommendations to improve patient safety. A mixed method approach was used to interpret the data and uncover the reasons for falls.

The first study was a secondary data analysis where 7,721 patient falls were examined. The data were taken from the hospital’s central incident reporting system between 2009 and 2014. Most falls occurred in the medicine and neurosciences units. The highest frequency of falls (901) occurred between 10:00 a.m. and 12:00 p.m., a time when staff were generally preoccupied with multiple tasks. Although most falls were not serious, there were 2,275 falls resulting in an injury and 16 resulted in death as a result of the fall. These findings and others were the impetus to follow-up with the next study concentrating on the validity of the fall risk assessment tool.

The second study was a predictive validity study examining 500 patient scores obtained from the Morse Falls Scale (MFS) on medicine units in the hospital. The MFS was used to assess patient risk for falling. Using a cut-off score of 25, the sensitivity was 98 percent, however, the specificity was only 8 percent. An MFS cut-off point of 55 provided the most balanced measure of sensitivity (87%) and specificity (34%) for accurate identification of fall risk, however still low. These results showed that a change on how the hospital assessed falls risk was indicated.

The third study was a multiple case analysis of patient falls in the same acute care hospital. The findings from eleven cases from two previous studies were explored further to identify key contributing factors which led to the falls. Findings included inadequate hospital policies, lack of staff education and patient cognitive and mobility issues while in hospital. A change in practice across all defense layers was recommended.


Patient falls, hospital incident reporting systems, fall prevention strategies, falls risk assessment tools, patient fall case studies