Health Care Operations Analysis to Reduce Attending Times for seniors presenting to the Emergency Department with a Fall

To examine the flow patterns in emergency departments when seniors present with falls, with the goal of improving care for these patients, reducing the time they spend in the ED, and to better understand the economic costs and the proportion of patients who receive health services to prevent future falls.

To examine the flow patterns in emergency departments when seniors present with falls, with the goal of improving care for these patients, reducing the time they spend in the ED, and to better understand the economic costs and the proportion of patients who receive health services to prevent future falls.

Research Summary

British Columbians aged 70 years or more, who fall and sustain injuries (that range from head injuries and fractures to other trauma) use 7% of Emergency Department (ED) beds and require over $180 million in direct health care costs annually. Preventive programs have been developed to help reduce the incidence and severity of falls among seniors but studies suggest that the majority of patients who present to the ED do not receive follow-up care or guidelines about falls prevention.

Pilot data collected from a consecutive sample of 50 senior patients who presented to the Emergency Department and did not require admission for fall-related injuries, indicated that these individuals spent a median of more than 6 hours in the department before being discharged. Patients who required admission spent over 14 hours in the ED before being moved to a hospital ward. In this follow-up study, involving ED staff, health authority decision-makers and health services researchers, the research team will assess the flow pattern in the Emergency Department when seniors present with falls. The research goal is to identify bottlenecks and opportunities to improve flow-through, reduce the amount of time that vulnerable seniors spend in the ED, improve the care that seniors receive, assess the economic cost of this population and to register what proportion of patients receive health services. In sum, the study aims to provide a rational basis for prevention of future falls among seniors.

Research Results

This study was designed to prospectively evaluate characteristics of elderly fallers’ ED experience including care received, flow through the ED and wait times. 100 patients (mean age 82.5 years) were recruited into the study over a one year period. 36% of fallers were hospitalized and 67% of these had subsequent in-hospital surgeries. On average, fallers who were discharged after the ED waited 88 minutes to see an emergency physician and spent 283 minutes in the Emergency Department. For those admitted to hospital the mean time spent in the ED was more than 14 hours, of which one hour was spent waiting for assessment by an emergency physician.

In only 30% of cases did the patients see the ED physician within the Health Authority’s recommended time period and in only 40% of patients was the entire ED experience completed within the recommended time.  The data indicate that efforts to improve flow should focus on patients who need admission as these involve more than one-third of those who present with a fall and contribute to the very long wait times that exceed quality indicators. The study identified bottlenecks and major cost drivers of treating falls in the Emergency Department and researchers worked with health authority staff to create new ideas for improving the process of flow-through for seniors presenting as a result of a fall. For example, there are plans for emergency departments to develop a checklist to assess the level of acuteness of seniors who present with a fall, to allow them to be screened rapidly so that those who are most unlikely to be admitted to hospital may be able to be discharged swiftly after appropriate assessment.  But given the difficulty of increasing inpatient beds – the reason for the long wait times for those admitted to hospital – the most feasible and economically rational solution may be to increase falls prevention efforts.