She had just washed her face and brushed her teeth. And then, while she was leaning over to put on some socks, it happened. Boom. She fell over onto her backside.

She called the nurse, who came to check on her. That nurse then set off the alarm bells. She paged the in-house hospitalist. She flagged me at the desk. The nursing supervisor arrived shortly thereafter.

Then the paperwork began: forms to fill out, progress notes to document the event. Each fall report goes to a falls committee, which reviews the case and seeks to determine what can be done to prevent such falls.

"So what's the big to-do?" my patient asked me after I was the third person to come in and examine her.

Falls are a big deal in hospitals these days. A 35-bed unit will likely see four to five falls a month. Thankfully, my patient didn't hit her head or suffer any bruises. But it could have been a lot worse.

She could have had a hip fracture, for example. More than 90 percent of hip fractures occur from falls. According to one recent British study, half of patients who sustained hip fractures in a hospital were dead within a year.

Other unforeseen injuries can occur as well, with related depression and anxiety, not to mention extended stays and an extra $4,000 on average in excess hospital charges.

The price of a fall is now one that the hospital has to bear. In the fall, the Centers for Medicare and Medicaid Services with the Centers for Disease Control and Prevention decided that hospitals would not get paid for higher reimbursement diagnostic codes if their patient had fallen during the stay.

The CMS argued that falls "should not occur after admission to the hospital."

But is this absolute mandate attainable? Falls are a complex phenomenon. In one study, nearly half the falls were related to toileting. And according to a recent editorial in the New England Journal of Medicine, they "are often the result not of medical errors but of diseases, impairments, and appropriate uses of medications and other treatments."

A patient without a history of falls may be admitted to the hospital for pneumonia. He may ask for a sleeping pill because of the difficulty of sleeping in a room with beeping alarms or a roommate who snores all night.

In any patient, especially the elderly, these pills can sometimes have adverse effects, especially in concert with their other problems. The next morning, the patient falls. How can you prevent it?

The answer is unclear. There is slim literature on how to avert falls in hospitals. One review suggests that at best, about 20 percent of hospital falls can be prevented. Interventions such as medication changes, removal of physical restraints, fall alarms, and exercise have gotten mixed reviews.

Some doctors worry that an unintended consequence of this government mandate could be the inappropriate use of physical restraints. It's counterintuitive, but studies show that physical restraints do not reduce risk of falls. They actually are associated with negative consequences in the hospital, such as agitation, immobility, pressure sores, and asphyxiation.

My patient didn't get restraints, but she did receive a more stringent alarm on her bed: If she tried to get out on her own, it would go off.

The patient also got a yellow bracelet and yellow tag on her door indicating that she was a fall risk. The nurse now would check her neurologic status and vital signs every hour for several hours.

Standard fall prevention also triggers "environmental rounds": Three times daily, the nurse goes through a checklist. Among several tasks, she makes sure the room is clutter-free, the call bells are in reach, the bed is in a low position, and the wheels are locked.

When I went back to see my patient the next day, she was feeling fine.

She felt well taken care of but was a little surprised by the hullabaloo made over her fall. "I've been branded with a Scarlet Letter," she told me, as she lifted up her wrist. A yellow band had marked her "Fall Risk."