Predicting Falls With the Morse Fall Scale: A Retrospective Assessment at the Veterans Health Administration

Accidental falls are the second most prevalent adverse event within hospital settings, including U.S.'s Veterans Health Administration (VHA), often resulting in injury and prolonging patient recovery. The Morse Fall Scale (MFS) is widely used to assess fall risk within patient settings. Despite its known limitations, it remains a key tool for determining which patients are at risk for falls across healthcare institutions. Veterans with a completed MFS, Care Assessment Need (CAN), and Charlson Comorbidity Index (CCI), admitted to a VHA hospital from July 1, 2020, to June 30, 2022, were included in this retrospective analysis. MFS total scores were captured using electronic health record data from the VHA's national Corporate Data Warehouse. Veterans were identified as having a documented fall through clinical notes. Logistic regression models were used to evaluate the tool's performance at predicting falls. Among 440,771 Veterans, 14,458 (3.3%) had a documented fall during their inpatient stay. On average, those who experienced a fall had higher MFS scores. However, despite this trend, this tool exhibited poor discrimination in the likelihood of falls. Although incorporating patient demographics, the CAN, and CCI into the model improved performance, the model still performed poorly when assessing fall risk. Although the MFS is a required component of clinical workflow in many hospital systems, including VHA, its suboptimal discrimination of fall risk undermines its practical utility. Improved risk models are needed to assess fall risk and from which appropriate fall prevention measures can be initiated.