Background: Neurosurgery patients are at higher risk of falls given the morbidity associated with their neurological disease. We present our department’s experience with in-patient falls. Methods: We analyzed our hospital’s database for Neurosurgery in-patient falls from January 1st till December 31st, 2015. Results: Of 1,317 patients admitted under Neurosurgery, 5% (n=63) had in-patient falls. CT head was done in 24% (n=15) of patients who had a fall and 93% (n=14) of the CT head post-fall was reported as no significant interval change. The combined cost of repeat CT imaging reporting no interval changes was approximately $ 7,000. One CT head post-fall showed worsening midline shift but did not impact management. One of the 78% (n=48) post-fall patients who did not get a CT head progressed to coma requiring emergent surgery and another patient suffered an isolated hip fracture requiring operation. 41% (n=26) of falls were from bed and 37% (n=22) were while ambulating. Leading diagnosis of in-patient falls was subdural hematoma (33%, n=21) and tumour (32%, n=20). Conclusions: Identification of risk factors for in-patient falls can reduce hospitalization costs. The highest number of in-patient falls occurs in patients with subdural hematoma and are likely to occur from a patient’s bed.