Effectiveness of a Multimodal Intervention Program for Older Individuals Presenting to the Emergency Department After a Fall in the Northern French Alps Emergency Network.

OBJECTIVE: Fall-related visits to emergency departments (EDs) are common among older individuals. We aimed to assess effectiveness of a healthcare intervention program for the management of elderly patients admitted to EDs after a fall. METHODS: Using a before-after observation method, we investigated ED healthcare staff practices related to fall-related injuries in 2010 (period 1) and 2012 (period 2) in 13 centers participating in the Northern French Alps Emergency Network. Following the identification of initial weaknesses, several information and training tools were introduced between the two periods to improve patient management. All individuals aged 75 years or over who presented to an ED after a fall were included in the study. We reviewed the completeness and quality of medical records during both periods and compared the rate of clinical-paraclinical check-ups performed, geriatric evaluation/assessment in the ED, and the 1-month recurrence of visits to the ED for the same reason. RESULTS: During period 1, a total of 2,425 falls were recorded, while 2,684 were reported in period 2. The 2012 medical charts contained significantly more information about risk factors than those of 2010. An electrocardiogram (64% vs. 53%; p < 0.001), biologic check-up (65% vs. 57%; p < 0.001), balance, orthostatic hypotension, and cognitive impairment tests were more often performed in 2012. There was no change in the hospitalization rate, although short-duration hospitalization in the ED was more frequent in 2012. Geriatrists were more often consulted by patients in 2012 (18% vs. 13%; p < 0.001) and more involved in ED evaluation and hospitalization. The intervention program had a beneficial impact on the fall recurrence rate (n = 29 [3.6%] in period 1 and n = 17 [2.0%] in period 2; odds ratio = 0.52; p = 0.037), which significantly decreased between 2010 and 2012. CONCLUSIONS: The intervention program was associated with a decrease of fall recurrence. Further efforts should be made in EDs to ensure a sustained level of satisfactory and long-lasting management of the elderly.

[Quality of care provided to elderly fallers in the emergency room]. / Qualité de la prise en charge aux urgences des patients âgés chuteurs.

BACKGROUND: recurrent falls are a major public health problem associated with high morbidity and mortality as well as increased dependence. Multifactorial intervention has been shown to reduce recurrence by 20% (Profet study). The French Health Authority (Haute autorité de santé or HAS) recommends since 2009 a systematic screening for and assessment of risk factors as well as the implementation of preventive measures. OBJECTIVES: to examine whether the management of falls in older patients discharged home from the emergency department is consistent with the HAS guidelines. METHODS: descriptive retrospective analysis of 1238 medical records of patients over 75 years, who consulted for falls from April to October 2010 in the emergency department of in 13 centers in the North-Alps region. The study is part of a program to improve the quality of care led by the French Network of North-Alps Emergency Departments (Réseau nord alpin des urgences, RENAU). RESULTS: Screening of risk factors for falls was documented in varying rates: electrocardiogram 29%, cognitive impairment 25%, functional assessment 16%, walking difficulties 11%, postural hypotension 5%. A comprehensive geriatric assessment was undertaken for 3.8% of the patients. CONCLUSION: risk factors for falls are insufficiently documented in elderly patients discharged home from the emergency room after a fall-related visit. Completeness rates are similar to those found in previous studies. A standardized protocol for older fallers, specifically adapted to the work routine in the emergency department could be useful. The RENAU has proposed an algorithm to streamline the orientation of older fallers and promote the use of geriatric network.