Effect of a practice guideline on the process of emergency department care of falls in elder patients.
OBJECTIVE
To determine the effect of a practice guideline on the process of ED care in a health maintenance organization.


METHODS
A prepost-intervention comparison with a one-year pre-intervention phase followed by a one-year post-educational intervention phase was used to study the effect of the guideline on ED care. Emergency physicians and nurses were provided the details of the guideline during a two-week interval between the two periods.


RESULTS
During the two years of the study, 1,140 pre-intervention and 759 post-intervention patients met study eligibility criteria. More patients were diagnosed as having had falls due to loss of consciousness, stroke, and seizures during the post-intervention period (pre-intervention 3.8% vs post-intervention 8.4%, p < 0.001). There was a significant improvement in documentation of six of ten history items: cause of fall (64.5% vs 72.9%), location of fall (54.7% vs 60.5%), ability to get up unassisted (5.4% vs 12.5%), long lie after fall (1.5% vs 10.1%), prescription medications (79.0% vs 92.2%), and Pneumovax immunization status (20.8% vs 43.0%); and two of the four physical examination items: visual acuity (1.5% vs 3.2%) and the "get up and go test" (1.3% vs 11.2%). Prescribing of calcium and vitamin D increased from 0% to 6.6%.


CONCLUSIONS
The educational intervention to the practice guideline for the ED management of falls in elders led to small but significant improvements in the documentation of selected history and physical examination items and the prescribing of calcium and vitamin D, and to a greater consideration of the causes of falls.
Baraff
L J
LJ
UCLA Emergency Medicine Center, Los Angeles, CA 90024, USA. lbaraff@ucla.edu
Lee
T J
TJ
Kader
S
S
Della Penna
R
R
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002140:California; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000451:nursing / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D010808:Physical Examination / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D000078329:Workforce