Section General Internal Medicine, Department of Internal Medicine, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
BMC Emerg Med. 2024 Oct 11;24(1):188. doi: 10.1186/s12873-024-01085-9.
Although indicated, referrals for multifactorial fall risk assessments in older adults with fall related injuries presenting at the emergency department (ED) are not standard. The implementation of a transmural fall-prevention care pathway (TFCP) could bridge this gap by guiding patients to multifactorial fall risk assessments and personalised multidomain interventions in primary care. This study aims to develop and evaluate implementation strategies for a TFCP.
In this mixed-methods implementation study, strategies were developed using the Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Matching Tool. These were evaluated with patients, involved healthcare professionals, and other stakeholders using the Reach, Adoption, Implementation, and Maintenance of the RE-AIM framework in two cycles. Patients of the TFCP consisted of frail community dwelling individuals aged 65 and over presenting at the ED with fall related injuries.
During the first implementation phase, strategies were focussed on assessing readiness, adaptability, local champions, incentives and education for all involved healthcare professions in the TFCP. Only 34.4% of eligible patients were informed of the TFCP at the ED, 30.6% agreed to a fall risk assessment and 8.3% patients received the fall risk assessment. In the second phase, this improved to 67.1%, 64.6%, and 35.4%, respectively. Strategies in this phase focussed on adaptability, obtaining sustainable financial resources, local champions, assessing readiness, and education. The implementation was facilitated by strategies related to awareness, champion recruitment, educational meetings, adaptability of TFCP elements and evaluations of facilitators and barriers.
The study outlined strategies for implementing TFCPs in EDs. Strategies included increasing awareness, utilising local champions, educational initiatives, adaptability of the TFCP, and continuous monitoring of facilitators and barriers. These insights can serve as a blueprint for enhancing fall prevention efforts for older adults in emergency department settings.
尽管有相关建议，但对于因跌倒而在急诊科（ED）就诊的老年跌倒相关损伤患者，转诊进行多因素跌倒风险评估并未成为常规做法。通过实施跨部门跌倒预防护理路径（TFCP），可以为患者提供多因素跌倒风险评估，并在初级保健中提供个性化的多领域干预，从而填补这一空白。本研究旨在制定并评估 TFCP 的实施策略。
在这项混合方法实施研究中，使用实施研究综合框架专家推荐的实施变革匹配工具，制定了策略。在两轮研究中，使用 RE-AIM 框架的可达性、采用度、实施度和维持度，评估了患者、相关医疗保健专业人员和其他利益相关者对这些策略的看法。TFCP 的患者由因跌倒而在 ED 就诊的 65 岁及以上的脆弱社区居住者组成。
在第一阶段的实施过程中，策略侧重于评估 TFCP 所涉及的所有医疗保健专业人员的准备情况、适应性、当地拥护者、激励措施和教育。在 ED 仅告知了 34.4%的符合条件的患者 TFCP，30.6%的患者同意进行跌倒风险评估，8.3%的患者接受了跌倒风险评估。在第二阶段，这一比例分别提高到了 67.1%、64.6%和 35.4%。这一阶段的策略侧重于适应性、获得可持续的财务资源、当地拥护者、评估准备情况和教育。通过与意识、拥护者招募、教育会议、TFCP 元素的适应性以及促进者和障碍的评估相关的策略，实施得到了促进。
本研究概述了在急诊科实施 TFCP 的策略。这些策略包括提高认识、利用当地拥护者、开展教育活动、适应 TFCP 以及持续监测促进因素和障碍。这些见解可以为加强急诊科老年患者的跌倒预防工作提供蓝图。
