Ryan Duffy, Padideh Imenikashani, Tymeeka Davis, Steven Fairbanks, Folake Ogunmola, Laura Previll, Brian Schneider
Inpatient falls are a common and preventable source of harm among hospitalized patients. At a Veterans Health Affairs medical center, we implemented a mobility-first, multidisciplinary intervention using sequential Plan-Do-Study-Act cycles, including redesigned activity orders to "mobilize unless contraindicated," physical therapist-led education, and interdisciplinary fall huddles with rapid feedback. Over 18 months, total falls decreased by 34%, from 7.6 to 5.0 per 1000 bed-days, and injurious falls decreased by 46%, from 2.4 to 1.3 per 1000 bed-days, with no increase in staff injuries. This low-cost, scalable intervention suggests that standardizing mobility assessment, communication, and execution may reduce inpatient falls.