Virtual Observation Units: A Novel Disposition for Older Adults With Falls From the Emergency Department

Virtual observation units (VOUs) are being implemented across the country and serve as a model for patients to receive observational-level care at home. Falls are a leading cause of emergency department (ED) visits in the geriatric population and can cause substantial morbidity or mortality. Despite ED guidelines recommending fall-risk evaluation, the ED does not typically assess future fall risk given limited resources. We created a novel pilot VOU Falls Program that allows certain older ED fall patients to undergo fall-risk evaluation in their homes. In this concept paper, we discuss new care delivery models and how our VOU Falls Program integrates Mobile-Integrated Health paramedics, telemedicine emergency physicians, with fall-risk evaluation in the home. This novel VOU Falls Program includes home safety, functional testing, and fall-risk medication evaluations, components that are difficult to conduct in the ED, with the aim of reducing recurrent falls. It serves as an opportunity for emergency physicians to be at the forefront of a rapidly evolving area of care integrating Mobile-Integrated Health, telehealth for geriatric patients.