Memorial Emergency Department Fall Risk Assessment Tool: Identifies Substantially More At-Risk Emergency Department...

Fall-risk screening in the emergency department is challenging because vulnerability may arise from transient cognitive, behavioral, and physiologic changes that evolve over minutes to hours. Inpatient-derived tools may underidentify these emergency department-specific risk states. This quality improvement project evaluated whether the Memorial Emergency Department Fall Risk Assessment Tool identified a higher proportion of at-risk encounters than the Schmid Fall Risk Assessment Tool when both were applied to the same audited encounters.

This paired-comparison quality improvement project was conducted in an adult emergency department in Northern California. Implementation was guided by Lippitt's phases of change. Retrospective chart audits from the postimplementation period were reviewed for paired Memorial Emergency Department Fall Risk Assessment Tool and Schmid classifications. Fall risk was defined as a score of 3 or higher on each tool. McNemar's test evaluated discordant paired classifications.

Of 1203 unique audited encounters, 1189 had complete paired documentation. The Memorial Emergency Department Fall Risk Assessment Tool classified 662 encounters (55.7%) as at risk compared with 339 encounters (28.5%) using Schmid. Discordant classifications favored the Memorial Emergency Department Fall Risk Assessment Tool (348 tool only vs 25 Schmid only). McNemar's test was 277.97 (P<.001), and the matched-pair odds ratio was 13.92 (95% CI, 9.28-20.89).

The Memorial Emergency Department Fall Risk Assessment Tool identified substantially more at-risk ED encounters than Schmid did in paired audits, supporting the use of an emergency department-specific screening approach to improve recognition of transient fall-risk states in emergency nursing practice.