title: Effects of emergency department Care Coordination Team referrals in older people presenting with a fall.
abstract: OBJECTIVE
  The study aims to describe the characteristics of patients presenting to an ED with a fall and evaluate multidisciplinary Care Coordination Team (CCT) referrals on patient outcomes.
  
  
  METHODS
  A single-centred retrospective analysis of electronic data at an adult tertiary hospital was performed using data from 2004 to 2009 of presentations for patients aged 65 years or over with a fall. The primary outcome measure was representation to hospital within 30 days, comparing patients referred to CCT and those not referred. Secondary outcomes were differences in demographic characteristics, mode of arrival, triage score and readmission.
  
  
  RESULTS
  The proportion of ED patients presenting with a fall and their mean age is stable over time. From 2006 to 2009, 5162 fallers were referred to CCT in a decreasing trend, but with increased urgency. Statistically significant predictors for being referred to CCT were increasing age, being female, arriving by ambulance, being transferred from a nursing home and higher socioeconomic category. Arrival by ambulance and a history of previous falls were associated with representation and readmission. A decreasing trend from 2006 to 2009 was seen in rate ratios and odds ratios via regression modelling for both representation and readmission in patients referred to CCT.
  
  
  CONCLUSIONS
  Maturing of the CCT is associated with a decrease in representation and readmission rate. Over time, the CCT attended higher urgency patients associated with stable admission rates. These associations were not significant and the clinical effectiveness of ED CCTs requires further examination.
authors.affiliation: Occupational Therapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Kristie J
authors.initials: KJ
authors.lastname: Harper
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Gibson
authors.forename: Annette D
authors.initials: AD
authors.lastname: Barton
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Petta
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pearson
authors.forename: Antonio
authors.initials: A
authors.lastname: Celenza
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014218:Triage / Q000458:organization & administration* / Q000706:statistics & numerical data; D014904:Western Australia
keywords: Interdisciplinary Health Team; accidental; aged; emergency medicine; fall