Patient falls are a common complication of hospitalisation. Use of restraints in patients who are perceived to be at risk for falling may lead to injury and even death.To determine the frequency of falls and fall-related injuries and the contribution of restraints in a hospital population.We analysed incident reports of falls for a single year from a large teaching hospital. Results The fall rate per 10,000 patient days was 13.2 (95%CI 11.6-14.8). Fall rate increased dramatically with increased age. Eighty-two (30.7%) falls resulted in injury, of which 6 (7.3%) were serious. Injuries occurred in 71/247 (29%) unrestrained falls and in 11/20 (55%) falls in patients who were restrained. Injuries were more severe in falls with restraints in place (p < 0.0001).Restraint use is associated with increased severity of injury in hospital patients who fall.