Emergency Department Visit Outcomes of a Multicenter Randomized Trial of a Fall Prevention Intervention

Emergency department (ED) visits by older adults for falls are an opportunity to initiate fall prevention interventions. The GAPcare II trial tested an effective ED-based fall prevention program at two health systems. Our objective was to assess successful completion of intervention processes across sites including consultation completion rates, time to consultation, consultation duration, and types of recommendations made.

Community-dwelling adults ≥ 65 years old presenting to three EDs (two in Rhode Island, one in Colorado) within 7 days of an accidental fall who were expected to be discharged and were without mobility-limiting injuries.

GAPcare II was a randomized controlled trial conducted from August 2021 to January 2025. Participants were randomly assigned to intervention (pharmacy and physical therapy (PT) consultations) or usual ED care arms. Pharmacists reviewed medications for fall risk and recommended modifications. Physical therapists performed validated mobility/balance assessments and provided recommendations for assistive devices, outpatient services, and disposition.

Of 852 eligible ED patients, 196 were enrolled (96 intervention, 100 control). Participants' median age was 78 years, 68% were female, and 83% were white. In the intervention arm, 93% received pharmacy consultations and 83% received PT consultations. Median time from initial consultation request to bedside evaluation was 24 min (pharmacy) and 47 min (PT). Pharmacists recommended changing medication timing (26%), stopping fall-risk medications (19%), and dose adjustments (18%). Physical therapists recommended assistive devices (66%), outpatient services (36%), and skilled nursing facility admission (25%). ED length of stay did not differ between the intervention and usual care arms (4.6 vs. 4.4 h, p = 0.90).

The GAPcare II trial demonstrated that an ED-based fall prevention program is feasible to implement across two health systems with varied operations, volume, and staffing with similar results. Consultations generated actionable recommendations and did not prolong ED length of stay.