Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Background: Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time.Purpose: The aim of this studywas to determinewhether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups.Methodology/Approach: We conducted a 54-month (July 2006YDecember 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators® (2007).We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression.Findings: A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95%confidence interval [CI] [0.85, 0.99]),Magnet status (OR = 0.49, 95%CI [0.35, 0.70]), and bed size greater than 300beds (OR=0.70,95%CI [0.51, 0.94])were significantly less likely tobe categorized in the ''consistently high'' fall rategroup.