Mobility-first teamwork reduced hospital falls Mobility-first workflows were associated with fewer inpatient falls.
*Pre-post quality improvement study; Level 4 (OCEBM).

Citation

Duffy R, Imenikashani P, Davis T, et al. Reducing inpatient falls with a mobility-first, multidisciplinary intervention at a VA medical center. Journal of Hospital Medicine. 2026;1-6. doi:10.1002/jhm.70418

Background

Inpatient falls are common, harmful, and often preventable. Veterans may have higher fall risk because of mobility problems and cognitive impairment.

Patients

Hospitalized patients on four medical-surgical units at a 151-bed Veterans Affairs tertiary referral center. No patient exclusion criteria were reported.

Intervention

A mobility-first program using physical therapist-led staff education, clearer activity orders to “mobilize unless contraindicated,” bedside mobility assessment with the Johns Hopkins Highest Level of Mobility Scale (1 to 8), and weekly team fall reviews with rapid feedback.

Control

Historical usual care before the intervention.

Outcome

Total falls, unique fallers, injurious falls, staff injuries, activity order quality, and fall review completion.

Follow-up Period

18 months.

Results

Outcome Baseline After intervention Change
Total falls 7.6 per 1000 bed-days 5.0 per 1000 bed-days 34% decrease
Unique fallers 5.8 per 1000 bed-days 4.2 per 1000 bed-days 28% decrease
Injurious falls 2.4 per 1000 bed-days 1.3 per 1000 bed-days 46% decrease
Staff injuries from patient handling 0.09 per 1000 bed-days 0.04 per 1000 bed-days Decreased

Statistical process control charts showed special-cause improvement. This was not a randomized trial, and confidence intervals were not reported. The original target of 4.0 falls per 1000 bed-days was not reached.

Limitations

Single-center Veterans Affairs study limits generalizability. The before-after design cannot prove causation. Other fall-prevention efforts occurred during the study. The study could not separate which intervention components mattered most and lacked prospective patient-level mobility tracking.

Funding

No additional funding; authors reported no conflicts.

Clinical Application

Hospitals should consider standardizing mobility orders, staff training, and fall reviews; evidence is promising but not definitive enough to mandate practice.