A nurse-managed, individually tailored falls prevention plan administered for at least 20 months did not significantly reduce risk of serious fall injuries in older adults at high risk for falls, according to the results a recent study.1

“Many factors may have played a role in the negative findings in this study,” says Rosaly Correa-de-Araujo, MD, MSc, PhD, one of the study’s authors and the senior scientific advisor to the director at the National Institute on Aging’s Division of Geriatrics and Clinical Gerontology.

It is possible some participants did not mitigate all possible fall hazards, such as making changes in their home environment, exercise programs, or avoiding medicines that increase fall risk. “There are strategies to reduce fall rates, both universal measures and patient-specific measures, in the ED setting,” Correa-de-Araujo says.

When a patient comes to the ED, it is an opportunity to implement a multifactorial falls-injuries preventive program, Correa-de-Araujo offers. More than one-third of falls in hospitals result in injury, such as serious fractures, head trauma, lacerations, or internal bleeding.2 “Preventing falls and related injuries in hospitals is challenging,” Correa-de-Araujo laments.

It involves managing medication side effects, confusion, and frequent toileting needs, as well as the ED’s physical design and environment. “Research is limited regarding falls and injuries in EDs,” Correa-de-Araujo notes. “The complexity of their patient populations presents challenges.”

Eighty-four percent of 102 ED providers surveyed believe all geriatric patients should be screened for fall risk.3 Seventy-six percent also believe if a geriatric patient was identified as at risk for falls, that patient should go through an intervention in the ED.

However, ED providers were unwilling to spend lots of time on it; 46% were only willing to spend less than two minutes. “The perception is that it takes longer than it actually does,” says Kathleen Davenport, MD, the study’s lead author.

It does not have to be an EP or ED nurse who handles the screening. It could be a nurse assistant or other staff member. “The best screening tool is one that can be done by anyone in the department, and doesn’t require any additional equipment or space,” says Davenport, a clinical assistant professor in the department of emergency medicine at University of North Carolina School of Medicine.

Chris Messerly, JD, a partner at Minneapolis-based Robins Kaplan, has handled multiple ED fall cases. Not all turn out to be malpractice cases.

“If a plaintiff’s lawyer is giving a choice of a medical malpractice claim or a premises liability claim, it is always a much easier route to go with a premises liability claim,” Messerly says. One hospital was sued because a patient fell on a wet floor while entering the ED. The water was from a leaky pipe. “The claim was a premises liability claim, not a malpractice claim,” Messerly recalls.

Messerly also has handled many medical malpractice claims against EDs for patient falls. Most plaintiffs were known to be at risk for falling for one reason or another. The injuries happened when the patients stood from a wheelchair or an examination bed.

“If such a person is left unattended and they fall, the ED may be responsible,” Messerly cautions. “These claims are actually quite common.”

Some ED fall cases involved serious consequences, such as fractured skulls. The plaintiff attorney’s expert will look for evidence that the ED providers knew (or should have known) the patient was at risk for falling and took no precautions. If both can be proven, says Messerly, “the healthcare provider is responsible for the harm.”

REFERENCES

  1. Bhasin S, Gill TM, Reuben DB, et al. A randomized trial of a multifactorial fall injury prevention strategy. N Engl J Med 2020;383:129-140.
  2. Agency for Healthcare Research and Quality. Falls.
  3. Davenport K, Cameron A, Samson M, et al. Fall prevention knowledge, attitudes, and behaviors: A survey of emergency providers. West J Emerg Med 2020;21:826-830.