A multi-faceted intervention to implement guideline care and improve quality of care for older people who present to the emergency department with falls

BMC Geriatrics

Research Article

Ian Dey¹  Yusuf Nagree²  Nicholas Waldron³  Jianguo Xiao⁴  Leon Flicker⁵ 

[1] Department of Emergency Medicine, Armadale Kelmscott Memorial Hospital, Perth, Australia;Department of Emergency Medicine, Armadale Kelmscott Memorial Hospital, Perth, Australia;Fremantle Hospital Emergency Medicine Research Unit, Discipline of Emergency Medicine, University of Western Australia, Perth, Australia;Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Australia;Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Australia;Epidemiology Branch, Department of Health Western Australia, Perth, Australia;Western Australian Centre for Health and Ageing, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia;

关键词: Emergency Department;    Western Australia;    Guideline Care;    Care Index;    Injurious Fall;   

DOI  :  10.1186/1471-2318-11-6

 received in 2010-08-26, accepted in 2011-01-31,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundGuidelines recommend that older people should receive multi-factorial interventions following an injurious fall however there is limited evidence that this is routine practice. We aimed to improve the delivery of evidence based care to patients presenting to the Emergency Department (ED) following a fall.MethodsA prospective before and after study was undertaken in the ED of a medium-sized hospital in Perth, Western Australia. Participants comprised 313 community-dwelling patients, aged 65 years and older, presenting to ED as a result of a fall. A multi-faceted strategy to change practice was implemented and included a referral pathway, audit and feedback and additional falls specialist staff. Key measures to show improvements comprised the proportion of patients reviewed by allied health, proportion of patients referred for guideline care, quality of care index, all determined by record extraction.ResultsAllied health staff increased the proportion of patients being reviewed from 62.7% in the before period to 89% after the intervention (P < 0.001). Before the intervention a referral for comprehensive guideline care occurred for only 6/177 (3.4%) of patients, afterwards for 28/136 (20.6%) (difference = 17.2%, 95% CI 11-23%). Average quality of care index (max score 100) increased from 18.6 (95% CI: 16.7-20.4) to 32.6 (28.6-36.6).ConclusionsA multi-faceted change strategy was associated with an improvement in allied health in ED prioritizing the review of ED fallers as well as subsequent referral for comprehensive geriatric care. The processes of multi-disciplinary care also improved, indicating improved care received by the patient.

【 授权许可】

CC BY   
© Waldron et al; licensee BioMed Central Ltd. 2011