Problem: Older adults frequently present to ED following a fall for assessment and management. The quality of this care varies depending on time of presentation, activity levels within the hospital and staffing factors. An ED Falls Pathway was introduced in April 2024 at a medium-sized hospital in Perth, WA as a multidisciplinary initiative to standardise assessment and management in adherence to current best practice.
Design Methods: This retrospective cohort study evaluated ED falls pathway implementation. Eligible patients were promoted onto a pathway of standardised assessments (e.g. postural BPs, BSLs, ECGs), interventions, and targeted outpatient appointments (e.g. RITH, physiotherapy, social work). The primary outcome was a combined completion rate for ED assessments.
A record review compared outcomes between three cohorts: a 2023 cohort (n=27) pre-implementation, a second pathway “soft launch” group (n=110) collected April-May 2024, and a third (n=126) collected August-October 2024 following pathway consolidation via introduction of a specialised decision-support resource.
Practice Change: Combined assessment completion rates increased following pathway consolidation, by 71.02% over the 2023 baseline (25.40% vs 43.44%, p=0.0098) and 71.97% over the 2024 “soft launch” (25.26% vs 43.44%, p<0.001). The 2023 baseline and 2024 “soft launch” had similar rates (25.40% vs 25.26%, p=0.9433). A reduction in post-ED appointments was observed comparing the 2024 cohorts (%patients with ≥1 appointments: 47.27% vs 35.71%, p=0.09538), providing preliminary positive signs that patients may require fewer upstream healthcare contacts.
Conclusions: This single-centre study demonstrated the effectiveness of an ED falls pathway to improve early care and coordinate adherence to current best practice.