Screening and assessment of falls risk in the emergency department

Falls are a source of harm, repeat emergency department visits and hospital admission for older adults. Undertaking a comprehensive geriatric screening including falls-risk is recommended in guidelines for optimal older adult emergency department care.

A pragmatic prospective cohort study was undertaken to evaluate use of further falls-risk screening in older adults in a large tertiary Australian hospital emergency department. Primary outcome measures of interest were length of stay; discharge destination; 30-day and 90-day re-presentations.

Of 651 eligible cases, 320 were randomly recruited for further screening following consent. The implementation cohort spent an average 45 m longer in the emergency department with a greater proportion admitted to the short stay unit, staying there longer than a comparison cohort. There were significantly fewer 30-day fall-related representations (2.9 %) in the implementation cohort.

Despite a small reduction in emergency department re-presentation within 30 days in the implementation cohort, hospital admission was not reduced. Further research is needed to examine any cost-benefit ratio of additional falls-risk screening and intervention in emergency departments.