In-patient falls have been the biggest single category of reported hospital patient safety incidents since the 1950s. This may be due to a combination of patient-related (intrinsic) and environmental factors. Interventions have mostly followed a series of sequential steps: assessment; communication; monitoring; patient modification; and environment modification. This study explored the contribution of environmental factors in 26 reported un-witnessed patient falls using staff interviews and location mapping. It was found that the location of the fall seemed to be associated with the position of the bed rail and that very few of the patients were wearing shoes or socks at the time of the fall. In the US, hospitals may not be reimbursed for falls if they are categorised as ‘never events’ (events that should never occur).