Improving the management of older patients presenting to the Emergency Department post fall

Ms Alannah Cooper1,2, Ms Naomi Leyte1, Ms Sandy Dumas1, Dr Bhaskar Mandal1, Dr Glenn Arendts1,3
1Fiona Stanley Hospital, Murdoch, Australia, 2St John of God Subiaco Hospital, Subiaco, Australia, 3University of Western Australia, Crawley, Australia

Introduction: Falls are one of the most common reasons older people present to an emergency department (ED), yet many falls patients are given a low priority for care and their assessments are often delayed and suboptimal. At Fiona Stanley ED, at least 50 people per week aged 65 or over present with ‘low risk’ falls, and almost as many again with falls associated with serious illness or injury.
Aim: An ED Falls Pathway was created to comprehensively rework the assessment of low risk falls which aimed to a) reduce the ED length of stay; b) maximise safe discharge rates; c) manage common issues associated with falls such as cognitive impairment and polypharmacy; and d) improve the inpatient care of admitted falls patients.
Method: A multidisciplinary committee convened to address the management of falls patients and used evidence from the literature and clinical expertise to create a falls pathway for all patients aged 65 and over presenting to emergency with a fall. This pathway utilises environmental management strategies, nursing risk screen, cognitive assessment, and reviews of medications, mobility and function for all falls patients. There are specific streams for admission and discharge to maximise safety and outcomes for the patient and the hospital system.
Results: By July 2017, 57% of eligible patients were triaged to the Falls Pathway and 79% of these patients were discharged home from ED. Implementation of the ED Falls Pathway saved 2752 bed days between July 2016 and July 2017 with an estimated saving of $3.6 million. In falls patients who required admission from ED the average length of stay reduced from 6.5 days to 3.6 days.

Alannah has a clinical background in emergency nursing and has worked in research for over five years. At Fiona Stanley hospital she is employed as a clinical research nurse working with the Centre for Clinical Research in Emergency Medicine. Alannah also works in nursing and midwifery research and is currently undertaking an MPhil.