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And now to a widespread problem in hospitals. Usually, it's high drama mistakes that end up in headlines, such as the amputation of the wrong limb or a surgical tool left inside a body. But the number one reason for injuries at hospitals is much less dramatic: it's patients falling down.

From member station WBUR, Sacha Pfeiffer reports.

SACHA PFEIFFER: About a year ago, something tragic happened at Fairview Hospital in Western Massachusetts.

Ms. ELLEN BECKWITH (Nurse, Fairview Hospital): All of a sudden, out of nowhere, we heard a humongous thud. And not only did we hear it, but we felt it throughout the whole unit.

PFEIFFER: Nurse Ellen Beckwith was working on that floor.

Ms. BECKWITH: So we all went running, and this little lady had gotten up. And we're not sure if she had stood and turned or just stood and fell, but fell backwards. And we have closets that have a metal sill and she had hit the back of her head on that sill.

PFEIFFER: The patient who had fallen was 90 years old. At first, she seemed fine. She was awake and talking, and her only complaint was a sore back. An hour and a half later, that all changed.

Ms. BECKWITH: All of a sudden, she went unresponsive and vomited. And she was never responsive after that. She died not long into the early morning hours.

PFEIFFER: The cause of death was a traumatic brain injury from the fall. The accident was devastating for Fairview staff. So the hospital decided that even though it already had a fall prevention program, it could be more aggressive.

Ms. BECKWITH: These are our rooms and our little stars on the outside. That is our first sign: you know that this person in this particular room is a fall risk.

PFEIFFER: Beckwith points to one way the hospital now identifies patients at risk of falling: outside several rooms are big stars made of bright, yellow construction paper.

Ms. BECKWITH: You can look in and see on the closet, there's a yellow sheet. That individual is somebody that's a high, high fall risk, so they should be being rounded on every half hour versus every hour.

PFEIFFER: All patients admitted to Fairview are evaluated for the risk of falling, then they're re-evaluated daily. High-risk patients also get yellow blankets and yellow socks and one more thing: bed alarms. If a patient at risk of falling tries to get out of bed unattended…

(Soundbite of music)

PFEIFFER: …that blaring tune sends nurses running to help. And these precautions aren't just for elderly people. Debra Schermerhorn(ph) is only 45, but even she felt unsteady a day after gall bladder surgery at Fairview.

Ms. DEBRA SCHERMERHORN: When you start getting up, your feet aren't where they should be, and you really could feel that all the oars weren't in the water. You're dopey, for lack of a better word.

PFEIFFER: Patient falls are the most common injuries reported in hospitals. So, many hospitals are making simple changes - for example, no diuretics before bedtime. That's because a full bladder might tempt patients to make a nighttime bathroom trip by themselves - a classic scenario for a fall.

Some hospitals avoid drugs that could impair a patient's balance. They're also using beds that can be lowered to the floor so that if patients fall out, they won't fall far.

All this patient protection isn't just happening out of benevolence. In some states, hospitals now have to publicly report their fall rates. There's also a financial stick: Medicare will no longer pay for costs related to certain hospital falls. Those falls can add more than $4,000 in excess charges per hospitalization.

But Sharon Inouye, a Harvard Medical School professor, worries these fall prevention efforts could have a dark side.

Dr. SHARON INOUYE (Professor of Gerontology, Harvard Medical School): My concern is that in the desire to prevent falls from occurring, hospital staff may want to do things like put up more restraining devices or not let people get up out of bed.

PFEIFFER: Instead, Inouye wants hospitals to get patients up and walking as soon as possible, because when a person is confined to bed…

Dr. INOUYE: They lose muscle mass. They start to get weak. They lose their balance ability and that, of course, predisposes to falls.

PFEIFFER: Many hospitals say they restrain patients only as a last resort. They say these other techniques are helping reduce falls. And now that hospitals' reputations and financial health are on the line, that's strong incentive to keep driving those fall rates down.

For NPR News, I'm Sacha Pfeiffer.

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