Research Abstract: Free Paper - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Background In Western Australia (WA), there were 42160 falls related presentations to emergency departments (ED) in 2020. Since 2017, an ED falls pathway was implemented at Fiona Stanley Hospital (FSH) to provide a standardised and systematic approach to older adults presenting with a fall. The pathway embeds direct specialist aged care assessment in the ED, supports safe and effective discharges, and facilitates direct admissions to geriatric inpatient units in order to reduce admission rates and hospital length of stay.

Methods Patients over the age of 65 years presenting with a fall are streamed to the falls pathway as per inclusion criteria. Patients are screened for cognitive impairment, polypharmacy, mobility and discharge risk. Those deemed complex and high risk are reviewed by a geriatrician who undertakes a comprehensive geriatric assessment including allied health and pharmacy review.  

Results Approximately 2500 older adults presenting with falls were streamed to the falls pathway per year (Figure 1). The discharge rate from the ED and emergency short stay unit (ESSU) has been steadily around 70 % (Figure 2). Direct inpatient admissions to geriatric units increased with the establishment of the geriatric Rapid Assessment and Treatment Unit (RATU) (Figure 3). Overall, the average inpatient length of stay has reduced from 5 days prior to the pathway introduction and been maintained around 2 days (Figure 4).

Conclusion The falls pathway model has been feasible and sustainable increasing discharges directly from the ED as well as facilitating direct access to geriatric inpatient units and decreasing the average inpatient length of stay.