title: Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program.
abstract: BACKGROUND
  Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model.
  
  
  METHODS
  Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL.
  
  
  RESULTS
  Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work consultation (n=162, 44%).
  
  
  CONCLUSIONS
  The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.
authors.affiliation: Case Western Reserve University School of Medicine, Department of Medicine, Cleveland, Ohio; Louis Stokes VA Medical Center, Department of Medicine, Cleveland, Ohio.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Huded
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Dresden
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Gravenor
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois.
authors.forename: Theresa
authors.initials: T
authors.lastname: Rowe
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Lindquist
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D005684:Gait; D015577:Geriatric Assessment / Q000379:methods; D005851:Geriatric Nursing / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods