OBJECTIVE: This study aimed to analyze accident reports of hospitals across Japan, and identify the characteristics of fall occurrence in hospitals and the factors influencing falls that require additional medical care. METHODS: Data on falls that occurred inside hospitals between 2012 and 2021 were collected from the Project to Collect Medical Near-Miss/Adverse Event Information database of the Japan Council for Quality Health Care. The data were analyzed using binomial logistic regression analysis (the reduced variable method, likelihood ratio) with the requirement/nonrequirement of additional medical care as the dependent variable. RESULTS: Out of all falls that occurred between 2012 and 2021, 78.9% required additional medical care. Of these, 758 reported irreversible disability, and 57 reported deaths. Most falls occur in the hospital room or corridor. The orthopedic surgery and psychiatry departments were the most common departments associated with fall occurrence. Gait disturbance and dementia/amnesia were the most common conditions prevailing before the fall. Weekdays (odds ratio=1.151), mornings (odds ratio=1.117), and two-shift work schedules (odds ratio=1.261) were the determinants of falls requiring additional medical care. CONCLUSIONS: Falls requiring additional care in Japanese hospitals were more likely to occur on weekdays and mornings. Staffing conditions, rather than months of experience and hours worked the week before, determined falls requiring additional medical care.