Reducing Post-Fall Emergency Department Transfer From Residential Aged Care Homes: The Falls Outreach and Residential...

We examined whether the 116 emergency department transfers from residential aged care homes prevented by an intervention that provided on-site assessment and management following a fall led to a detectable shift in system-level emergency department utilisation.

This 17-month before-and-after study was conducted at three metropolitan hospital emergency departments of a single health service in Melbourne, Australia. Monthly post-fall emergency department transfers from 108 residential aged care homes were compared before (1 May 2021 to 30 April 2022) and after (1 May 2022 to 30 September 2022) the intervention using two routinely collected administrative datasets. The primary analysis included patients eligible for the intervention. Sensitivity analyses examined patients ineligible for the intervention and a season-matched before period (1 May 2021 to 30 September 2021).

Mean (SD) monthly post-fall emergency department transfers from residential aged care homes among patients eligible for the intervention were 92.2 (14.9) before and 74.2 (7.2) after implementation (mean difference [95% CI]: 18.0 [2.9, 33.1], p = 0.023; season-matched: 28.2 [10.3, 46.1], p = 0.007). Monthly post-fall emergency department transfers from residential aged care homes among patients ineligible for the intervention did not significantly differ before and after the intervention (mean difference [95% CI]: 1.8 [-3.0, 6.7], p = 0.434; season-matched: 1.8 [-5.1, 8.7], p = 0.566). We detected 78% (n ≈ 90) of the verified 116 emergency department transfers prevented.

On-site assessment and management following a fall at residential aged care homes may reduce system-level emergency department utilisation. Examining sustainability and cost-effectiveness appears warranted.