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Printed on 7/21/2026
For informational purposes only. This is not medical advice.
STRATIFY is a bedside inpatient fall-risk screening instrument based on five binary clinical factors, producing a total score from 0 to 5. It is used in hospital settings to quickly identify patients who may benefit from intensified fall-prevention interventions.
Formula: STRATIFY total = sum of 5 binary fall-risk items (range 0-5).
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Five binary items each score 1 if present: (1) Admitted due to a fall; (2) Currently agitated with excessive restlessness or unpredictable behavior; (3) Visual impairment affecting daily functioning despite corrective lenses; (4) Urinary or bowel urgency or incontinence requiring frequent toileting; (5) Transfer or mobility impaired on nursing assessment. Score each item 0 (absent) or 1 (present) based on direct observation and clinical interview at admission.
Sum all five items to produce a total from 0 to 5. A score of 2 or higher is the high-risk threshold, achieving sensitivity approximately 93% and specificity approximately 88% in the original Oliver et al. validation. Scores 0-1 indicate lower risk and support standard precautions. Reassess whenever clinical status changes — new confusion, medication changes, acute illness, or deteriorating mobility — rather than only at fixed intervals.
Translate the score into prevention: Low risk (0-1): call bell accessible, bed lowest, non-slip footwear. High risk (2-5): bed alarm, hourly rounding, scheduled toileting, walking aid within reach, environmental hazard review, patient and family education, shift handover communication. Score 3+ or recent fall warrants physical therapy consultation and an individualized falls prevention care plan addressing each positive item specifically.
Admissions nurses, medical ward nurses
STRATIFY completes in under 2 minutes at admission for all patients over 65. Systematic admission scoring has reduced time-to-prevention-intervention and improved documentation of fall risk in UK hospitals where the tool was developed and implemented.
Inpatient nursing teams, charge nurses
The STRATIFY score provides standardized numeric risk communication. Including positive items in handover — 'admitted after a fall, incontinent, impaired mobility' — conveys the clinical picture efficiently without requiring a lengthy verbal summary from outgoing staff.
Orthopaedic nurses, surgical nurses
Particularly useful in surgical wards where patients have multiple risk factors: impaired mobility, agitation from anesthesia, visual impairment, and fall-related admission for fracture patients. Early high STRATIFY scores support proactive physical therapy involvement and early mobility protocols.
Geriatric consult teams, medical ward nurses
The agitation item captures a key mechanism by which delirium causes falls. A patient developing acute agitation scores a positive item, triggering intensified fall precautions simultaneously with delirium assessment, creating a natural bridge between fall prevention and cognitive management.
Healthcare IT, clinical informatics, nurse managers
The 5-item binary structure integrates naturally into EHR nursing admission flowsheets. Automated score calculation and threshold alerts allow systematic identification without relying on nurse interpretation of continuous scale results, improving compliance and reducing time-to-intervention.
A patient with score 1 at admission may reach score 4 within 24 hours after developing delirium, worsening mobility, and new urinary urgency. Protocols restricting reassessment to fixed intervals miss rapid risk escalation. Empower nursing staff to trigger reassessment whenever new risk factors emerge or existing factors worsen significantly.
Score based on whether vision limitation affects daily functioning during the current admission. A patient whose glasses are missing or broken may have clinically relevant visual impairment even if corrected acuity is good. Always ensure visual aids are present and being worn before scoring this item.
The mobility/transfer item is based on nursing-assessed performance, not patient self-report. Patients frequently overestimate their transfer abilities, especially those with cognitive impairment. Observe or formally assess transfer performance before scoring — do not base this on the patient's report of home function.
A common failure is scoring STRATIFY and placing a wristband without specific individualized prevention actions. A positive agitation item needs delirium evaluation; a positive incontinence item needs a scheduled voiding plan. Generic 'fall precautions' without item-specific targeting significantly reduces clinical impact.
For ICU step-down, neurology, and comprehensive fall-prevention programs, supplement STRATIFY with Morse Fall Scale or Hendrich II, which capture additional risk factors including fall history, IV access, and specific medication effects that STRATIFY does not include.
Score 3 from agitation + vision + mobility needs different interventions than score 3 from fall history + incontinence + mobility. Item-level documentation enables tracking which risk factors resolve or worsen and supports personalized prevention rather than a one-size-fits-all approach.
Validated in UK general hospital wards. International meta-analyses show pooled sensitivity approximately 72% and specificity approximately 61% — lower than the original study. Before replacing locally validated tools with STRATIFY, confirm acceptable performance in your specific patient population and unit type.
STRATIFY is a widely cited inpatient falls screening tool with variable external validation performance.
Higher STRATIFY totals indicate greater inpatient fall-risk signal and need for prevention measures.
Use during hospital admission and ongoing inpatient reassessment to flag high-risk patients.
Prediction performance varies by unit type and population; local validation and protocol adaptation are important.
For related assessments, see Morse Fall Scale, Tinetti POMA and Berg Balance Scale.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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