A multi-faceted intervention to implement guideline care and improve quality of care for older people who present to the emergency department with falls

Abstract

BackgroundGuidelines recommend that older people should receive multi-factorial interventions following an injurious fall however there is limited evidence that this is routine practice. We aimed to improve the delivery of evidence based care to patients presenting to the Emergency Department (ED) following a fall.MethodsA prospective before and after study was undertaken in the ED of a medium-sized hospital in Perth, Western Australia. Participants comprised 313 community-dwelling patients, aged 65 years and older, presenting to ED as a result of a fall. A multi-faceted strategy to change practice was implemented and included a referral pathway, audit and feedback and additional falls specialist staff. Key measures to show improvements comprised the proportion of patients reviewed by allied health, proportion of patients referred for guideline care, quality of care index, all determined by record extraction.ResultsAllied health staff increased the proportion of patients being reviewed from 62.7% in the before period to 89% after the intervention (P < 0.001). Before the intervention a referral for comprehensive guideline care occurred for only 6/177 (3.4%) of patients, afterwards for 28/136 (20.6%) (difference = 17.2%, 95% CI 11-23%). Average quality of care index (max score 100) increased from 18.6 (95% CI: 16.7-20.4) to 32.6 (28.6-36.6).ConclusionsA multi-faceted change strategy was associated with an improvement in allied health in ED prioritizing the review of ED fallers as well as subsequent referral for comprehensive geriatric care. The processes of multi-disciplinary care also improved, indicating improved care received by the patient.

The Determinants of Fall in the Elderly at the Geriatric Center of Ouakam (Senegal)

“…Sports activity was practiced by 22% of our population, and walking accounted for 91%. This rate is comparable to that obtained by Diallo [17] who found that 80% of the patients had walked once or several times a week. In fact, walking is a simple and accessible physical activity for the elderly, and it can be done in the neighborhood or even at home.…”

The profile and follow-up of patients who attend the Emergency Department following a fall

“…An initial starting point may be to evaluate current practice against international standards for falls management (NICE, 2004;Salter et al, 2006). But real changes in practice in this area requires a multidisciplinary approach and the development of protocols that include the implementation of evidenced based falls assessment tools and clear referral pathways (Hastings and Heflin, 2005;Waldron et al, 2011). ED nursing staff are in a position to take a critical lead role in driving such an evaluation and practice changes.…”

Systematic review of non‐transportation rates and outcomes for older people who have fallen after ambulance service call‐out

“…Multifactorial interventions have been shown to improve the outcome of people who have fallen who are seen and treated in ED [31] and a recent study undertaken in the UK provides evidence that an intervention offered to non-conveyed people who have fallen can make a significant and positive difference to patient health outcomes [12].…”