title: Emergency department management of falls in the elderly: A clinical audit and suggestions for improvement.
abstract: BACKGROUND
  Falls are a major source of injury in the elderly and their incomplete management is a cause for concern by health systems. The present study looks at the current state of managing fall victims in Iran and offers suggestions for improvement.
  
  
  METHODS
  This was a clinical care audit comparing the state of current care with an institutionally approved optimum. Patients aged 60 years and over presenting with a fall were evaluated and deficiencies in their care were recorded and categorized. These were presented to an expert panel, where the Delphi method was used to come up with a list of actions to address the deficiencies. Furthermore an educational program was implemented based on these suggestions. Chi-squared and t-test were used to evaluate the efficacy of this program in improving treatment. Linear regression analysis was used to find factors affecting care.
  
  
  RESULTS
  Overall 431 cases were reviewed. The most common errors during clinical examination were: not performing Romberg test (92.75%) and lack of physiotherapy consultation (82.75%). The educational program had a modest effect on improving the clinical audit processes (β = 3.79; P < 0.001) and medical interventions (β = 2.004; P = 0.002); however, performing the correct diagnostic tests was worse after the program (β = -1.21; P = 0.008).
  
  
  CONCLUSIONS
  There is a wide gap between the care services delivered in the management of falls and international standards. Therefore, measures should be adopted to close this gap. Education may have a modest positive effect in this regard.
authors.affiliation: Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Emergency Department, Emam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Hatamabadi
authors.affiliation: Community Medicine, Babol University of Medical Sciences, Mazandaran, Iran. Electronic address: sumshima@yahoo.com.
authors.forename: Shima
authors.initials: S
authors.lastname: Sum
authors.affiliation: Emergency Department, Qom University of Medical Sciences and Health Services, Qom, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Tabatabaey
authors.affiliation: Emergency Department, Emam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Sabbaghi
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement
keywords: Clinical management; Emergency department; Fall