# Nursing Unit Design and Hospital Falls

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Patient falls are the most common adverse events reported in hospitals.1-5 Each year, roughly one million
patient falls occur in United States (US) hospitals resulting in over 250,000 injuries and 11,000 deaths.6 Patient
falls cost hospitals due to increased lengths of stay, health care expenditures, and litigation. As of March 2015,
the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS) Patient Safety Information
System, a confidential and non-punitive reporting system, showed that falls were the most frequently reported
category of patient harm across the Veterans Health Administration (VHA).7
Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or
fatal hospital falls,8 there are significant gaps in our knowledge about the relationship between inpatient unit
design and fall rates. The few studies that have examined unit design have been conducted in a single hospital
or a small number of inpatient units, limiting generalizability.9,10 Furthermore, there have been no studies
focused on unit design and falls in VA medical centers (VAMCs). The VA's Office of Construction and Facilities
Management promotes evidence-based design.11 Thus, the overarching goal of this study is to identify unit
design factors contributing to inpatient falls within the VHA. This study addresses Strategy 6.3 of the 2014 VA
Blueprint for Excellence12 and Objective 3.3 of the 2014-2020 VA Strategic Plan13 both of which emphasize
design of VA space. Specifically, the Strategic Plan states that “VA will continue capital planning efforts to
provide safe, secure, modern, and sustainable infrastructure…” Our research will directly inform the VA's
efforts to renovate or build physical spaces that improve Veterans' safety.
To accomplish this, we are proposing a mixed methods study to explore the relationship between unit design
and patient falls in VA medical/surgical (med/surg) units. We will utilize a qualitative approach to investigate
staff and management perceptions with environmental factors that contribute to patient falls (Aim 1). We will
use quantitative approaches in Aim 2 to identify med/surg units with higher- or lower-than expected fall rates
and identify spatial and environmental factors that distinguish them.
The specific aims of this study are to:
Aim 1: Investigate front-line and management perceptions of and experiences with Veteran falls as they pertain
to inpatient environmental factors. We will conduct walk-through interviews in 12 med/surg units at the Malcom
Randall VAMC in Gainesville, the Lake City VAMC in Lake City, and the James A. Haley Veterans' Hospital in
Tampa with unit and facility personnel to identify environment-related fall risk factors at each site. Interview
findings will directly inform the development of an Environmental Assessment Survey to be conducted as part
of Aim 2, as well as, contribute to interpretation of Aim 2 results.
Aim 2: Quantify associations b...

## Key facts

- **NIH application ID:** 9676892
- **Project number:** 5I01HX002191-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** RONALD I SHORR
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-03-01 → 2021-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9676892

## Citation

> US National Institutes of Health, RePORTER application 9676892, Nursing Unit Design and Hospital Falls (5I01HX002191-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9676892. Licensed CC0.

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