Emergency Medicine, University of Western Australia, Level 2R Block, QEII Medical Centre, Nedlands, WA 6009, Australia; and Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. Email:
Department of Emergency Medicine, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. Email:
Aust Health Rev. 2020 Aug;44(4):576-581. doi: 10.1071/AH19187.
Objective Falls are a major cause of hospital-related costs in people aged ≥65 years. Despite this, falls are often seen as trivial and given low priority in an emergency department (ED), especially in the absence of overt major injury. ED systems that care for falls patients are often inefficient. The aims of this study were to: (1) design and implement a standardised and systematic approach to patients presenting to an ED after a fall; and (2) achieve hospital efficiency gains, such as reduced hospital length of stay, through implementation of this approach. Methods A prospective study was conducted with pre- and postintervention measurement of outcomes. The key features of the intervention were direct admission to an ED short stay unit, standardised assessment of cognition, medications, mobility and discharge risk, and access in the ED to a geriatric consultation service for complex patients. Results In the 12 months of the intervention, 1435 male and female patients aged ≥65 years were enrolled in the study. At the end of 12 months, these patients had significantly higher ED discharge (66% vs 46%; P<0.001) and, if admitted, shorter median hospital stays (6 vs 2 days; P<0.001) compared with the baseline pre-intervention phase. Analysis 1 year later revealed that these outcomes were sustained or further improved. Conclusion A systematic approach to falls in older patients attending the ED is feasible and beneficial. Decreased hospital stay and improved rates of effective discharge from ED back to the community are achievable and sustainable. What is known about the topic? Falls are common, serious and costly. Not identifying and managing falls risk factors is a common feature of ED practice. As a result, admission rates to hospital for patients who fall are high. What does this paper add? In this large study we have shown that a systematic approach to falls assessment is feasible, sustainable and results in higher discharge rates from the ED. What are the implications for practitioners? EDs are the gateway to a hospital bed. It is possible to redesign ED flow and bring front-loaded multidisciplinary geriatric care into an ED short stay environment, to the benefit of patients and health systems.
老年人≥65 岁的人群中，跌倒常常是导致医院相关费用的主要原因。尽管如此，在急诊科（ED），跌倒往往被视为微不足道的事情，优先级较低，尤其是在没有明显重大伤害的情况下。照顾跌倒患者的 ED 系统通常效率低下。本研究的目的是：（1）设计并实施一种针对 ED 跌倒患者的标准化、系统性方法；（2）通过实施这种方法来实现医院效率的提高，例如减少住院时间。
前瞻性研究，对干预前后的结果进行了测量。干预的关键特征是直接入住 ED 短期留观病房、对认知、药物、活动能力和出院风险进行标准化评估，以及为复杂患者在 ED 中提供老年科咨询服务。
在干预的 12 个月中，共有 1435 名年龄≥65 岁的男性和女性患者入组本研究。在 12 个月结束时，与基线干预前阶段相比，这些患者在 ED 出院率（66% vs 46%；P<0.001）和如果入院，住院时间中位数（6 天 vs 2 天；P<0.001）方面显著提高。一年后的分析显示，这些结果得到了维持或进一步改善。
对 ED 就诊的老年患者进行系统性跌倒评估是可行且有益的。降低住院时间和提高从 ED 有效出院率返回社区是可行和可持续的。
已知关于该主题的信息？
跌倒很常见，也很严重，而且代价高昂。在 ED 实践中，无法识别和管理跌倒风险因素是一个常见的问题。因此，跌倒患者的住院率很高。
本文增加了什么新内容？
在这项大型研究中，我们表明，对跌倒评估进行系统处理是可行的、可持续的，并能提高 ED 的出院率。
这对从业者有什么影响？
ED 是进入医院的门户。有可能重新设计 ED 流程，将多学科老年护理的前端加载到 ED 短期留观环境中，使患者和医疗系统受益。
