Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers

Abstract

Introduction: Falls are a frequent reason geriatric patients visit the emergency department (ED). To help providers, the Geriatric Emergency Department Guidelines were created to establish a standard of care for geriatric patients in the ED. We conducted a survey of emergency providers to assess 1) their knowledge of fall epidemiology and the geriatric ED guidelines; 2) their current ED practice for geriatric fall patients; and 3) their willingness to conduct fall-prevention interventions. Methods: We conducted an anonymous survey of emergency providers including attending physicians, residents, and physician assistants at a single, urban, Level 1 trauma, tertiary referral hospital in the northeast United States. Results: We had a response rate of 75% (102/136). The majority of providers felt that all geriatric patients should undergo screening for fall risk factors (84%, 86/102), and most (76%, 77/102) answered that all geriatric patients screened and at risk for falls should have an intervention performed. While most (80%, 82/102) answered that geriatric falls prevention was very important, providers were not willing to spend much time on screening or interventions. Less than half (44%, 45/102) were willing to spend 2-5 minutes on a fall risk assessment and prevention, while 46% (47/102) were willing to spend less than 2 minutes. Conclusion: Emergency providers understand the importance of geriatric fall prevention but lack knowledge of which patients to screen and are not willing to spend more than a few minutes on screening for fall interventions. Future studies must take into account provider knowledge and willingness to intervene. [West J Emerg Med. 2020;21(4)826-829.] the ED cares for such patients. In an attempt to standardize geriatric ED care, the Geriatric Emergency Department Guidelines were created. 6 One of the areas of focus was care for geriatric patients following a fall. The guidelines recommend implementing a fall risk assessment tool, using a multidisciplinary team that includes physical therapy, occupational therapy, social work, nursing, and physicians to arrange expedited outpatient follow-up. 6 However, current ED practice is not concordant with the ED fall guidelines. 7 It is not clear whether providers do not know about the guidelines or

Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement

“…Given the time pressures ED clinicians face, ED clinicians are likely to benefit from additional professionals to assist with time-consuming fall screening or fall prevention interventions as nurses, physical therapists, pharmacists, and geriatricians. 14 Engaging these partners in the ED rather than relying on referral to an outpatient clinic alone is important, because several studies reviewed here showed that ED fall patients rarely attended outpatient fall clinics after referral. 49,85 The group also identified that EMS personnel could play an important role in assessing fall…”

“…8 Although falls are common and costly, 9 and recent evidence suggest that falls may be preventable in the ED setting, 4,7,10 ED-initiated fall screening and prevention efforts are not widespread, 11 perhaps due to the ED environment; limited resources in time and staffing are barriers to implementing impactful change in ED management of falls. [12][13][14] Given the mortality and morbidity associated with falls, there has been interest within emergency medicine to address falls and initiate ED-based fall prevention efforts. The Society for Academic Emergency Medicine (SAEM) Geriatric Emergency Medicine Task Force recognized fall prevention as one of three priority areas over 10 years ago.…”

Automating risk stratification for geriatric syndromes in the emergency department

“…[29][30][31] The recent randomized controlled trial evaluating the GAPCare prevention program among ED patients, in contrast to STRIDE, showed a 50% reduction in return ED visits for falls. 32 Despite numerous guidelines recommending screening for mobility and fall risk in the ED, 5,19,26 and the existence of validated screening tools for mobility and falls risk, this screening has had limited uptake: studies suggest providers understand the importance of falls prevention, but have limited willingness to spend time on this task, 33 and often miss opportunities to modify falls risk. 34 Recent work has shown that using machine learning algorithms, return visits for falls can be predicted using only existing EHR data with discriminative capability similar to in-person screening that included functional testing.…”

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program

“…In a prior study, ED clinicians (physicians and advanced practice providers) have reported they are not willing to spend much time on fall risk identification and management, given tremendous time pressures and ED crowding, and a potential lack of understanding regarding the implications of a fall on older adults [ 15 ]. However, interventions during or soon after an ED visit might be a window of opportunity, given patients might be open to intervention at that time [ 16 ].…”