Purpose: This systematic mixed studies review (MSR) on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. Background: Falls were identified by the Centers for Medicare & Medicaid Services (CMS) as a non-reimbursed hospital acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 US hospital acquired condition (HAC) reduction program. In 2015, a Joint Commission alert identified patient falls as one of the top reported sentinel events, and the Occupational Safety and Health Administration (OSHA) added slips, trips, and falls as a focus for investigators' healthcare inspections. Variations in fall rates at both the hospital and the unit level is indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people and environment (SCOPE). Methods: The systematic literature review used MeSH terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers. Results: Following full text review, 27 papers were included and critically appraised using a dual method mixed methods critical appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients); and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. Conclusions: Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework, while considering the permanence of solutions
