# A Managerial Approach to Investigate Fall Risk in a Rehabilitation Hospital
## 4 Discussion
Considering the results inferable from fall screening tools used in the first step, it was found that, in our institute, the mean value of the registered Morse scale was 33.3 \(\pm\) 18.5. Since we ascertained that the Morse scale scores of several patients reached a total value greater than 45 (high risk of fall), following the instructions provided in the protocol, the Stratify score was also evaluated. In this study, the Stratify scale was assessed for 68 patients, and 33.8% of them had a fall risk with a score equal to 2. In the literature, to the best of our knowledge, no similar works have considered the Morse and/or Stratify scale scores as parameters to include in a managerial approach aimed at investigating (and potentially reducing) fall risk. For instance, previously, [PERSON] and [PERSON] [43] reported that the investigation of fall risks using the Morse scale was introduced later as an improvement measure. Although the introduction of Morse assessment effectively limited the registered falls, since several clinical areas of the hospital were considered, and since the previous literature reported the use of different fall risk assessment tools (alone or combined) in multiple different settings (for instance, the Hendrich Fall Risk Model II (HFRM II) in the case of an acute geriatric unit [47]; the revised Casa Collina Fall Risk Assessment Scale in three inpatient rehabilitation facilities [48]; the Conley and Stratify scales in multiple units of a university hospital [49]; the HFRM II and the Morse scale in an acute care setting [50]; the HFRM II and the Morse and Stratify scales in an acute care setting [51]), further investigations are needed to understand if the registered reduction in the number of falls in that setting (i.e., the hospital considered in the study by [PERSON] and [PERSON]) is consistent with the information the authors reported [43]. Moreover, in line with a previous study by [PERSON] et al. [52], who found that the use of the Stratify scale was not appropriate as the only tool for fall prevention programs, a logical and natural solution was to consider a multidimensional fall assessment followed by a multifactorial intervention. Focusing on similar aspects of the previous experts, a later investigation of the clinical risk management and patient safety of the Tuscany region (Italy) focused on, among the other objectives, designing an alternative risk assessment tool that could incorporate multiple features of the \"core set\" of risk factors considered by pre-existing fall risk assessment tools. The novel tool designed by these experts (ReTos) included all the core sets of the Conley, Morse, and Stratify scales (which are some of the most used scales, as indicated in this study). This strategy helped researchers to perform appropriate comparisons between these scales within the same population and to gain better insights into the information acquired (often in an inhomogeneous manner) from these three scales [53]. Overall, the evidence reported in these studies might also have inspired the experts of the _Istituti Clinici Scientific Maugeri_ in implementing the combined use of the Morse and Stratify scales, as reported in Section 2 and in the work of [PERSON] et al. [45]. Nevertheless, the current paper seems to be the first one that aimed to consider a multidimensional fall assessment, simultaneously with more than a single assessment tool [9] for patients at high fall risk, within the context of a managerial approach. The mean value of the Morse scale and the cataloging of patients following the Stratify cut-offs also allowed for the identification of the interventions/corrective measures to be adopted; in this study, standard preventive measures were applied to 169 patients (71.0%), while personalized preventive measures were applied to 69 patients (29.0%). Again, in the most similar previous study, [PERSON] and [PERSON] [43] did not consider these aspects in depth in their proposed managerial approach.