Implementation of Falls Screening for Older Adults in the Emergency Department

Research Objectives: To study implementation of the CDC STEADI Falls Screening program at the Durham VA HCS and related changes in clinical care processes (e.g., use of PT). In 2019, the Veterans Affairs (VA) Offices of Emergency Medicine and Geriatrics and Extended Care partnered with the Hartford Foundation and American College of Emergency Physicians to promote geriatric emergency medicine across the VA.

Design: Retrospective observational quality improvement study from Feb 1, 2022 - July 31, 2023 using descriptive statistics and the chi square statistical test for comparisons.

Setting: Durham VA HCS Emergency Department.

Participants: 7,409 patients aged ≥ 75 years.

Interventions: STEADI Falls Screening included the CDC 3 key screening questions, Orthostatic Blood Pressure, Medication Review, and Mobility Assessment.

Main Outcome Measures: Implementation of specific STEADI Falls Screening components (mobility assessment in particular). STEADI Fall Screen usage rates overall and according to time of day, frailty, acuity, discharge destination. STEADI Fall Screen results (positive vs negative) and according to age, frailty, chief complaint and any vs no receipt of physical therapy (PT) within 2 weeks of ED visit.

Results: Patients were more likely to have a STEADI Falls Screen if they presented during daytime hours (p < 0.001), had lower frailty scores (p < 0.001), had a lower acuity score (p < 0.001), or were discharged home (p < 0.001). The 4-Stage Balance Test proved to be the physical performance measure most suitable for assessment of mobility in our ED. Among those who had a STEADI Falls Screen (n=2999), 1125 (34.6%) screened positive. Patients were more likely to have positive result on the STEADI Falls Screen if they were older (p < 0.001), had higher frailty scores (p < 0.001) and presented with a chief complaint of falls (p < 0.001). Among those who had a positive result on the STEADI Falls Screen, 420 (37.3%) % were seen by PT within 2 weeks, compared to 220 (11.7%) among those who were STEADI negative (p < 0.001).

Conclusions: We were successfully able to implement STEADI including use of a validated tool to measure mobility. However, less than half of the older patients presented to the ED received the STEADI screen and it use appeared to be influenced by both systems and clinical factors. A positive STEADI screen appeared to identify the target population at greater risk of falls and STEADI screening results appeared to influence clinical care with increased likelihood of being seen by PT.

Author(s) Disclosures: No disclosures