Follow-up Attendance Among Older Adults After Emergency Department Discharge for Falls

Document Type

Conference Proceeding

Publication Date

4-23-2025

Publication Title

J Am Geriatr Soc

Abstract

BACKGROUND: Follow-up after an emergency department(ED) visit for a fall is crucial for preventing future falls. Knowledge offollow-up recommendations and identification of patients at greatestrisk for non-attendance will inform ED and health system interven-tions to improve care during the vulnerable period after ED discharge.METHODS: This is a retrospective review of patients ages ≥65discharged home from 9 EDs after a fall in Southeast Michigan during7 non-consecutive periods 1/2024-7/2024. The primary outcome was the percent adherence to PCP follow-up, defined as patient attendance at a PCP appointment within the specific time frame recommended by the ED provider. We called PCP clinics for patients (31) with missingfollow-up data in the EMR. RESULTS: The sample included 169 patients discharged home after a fall [excluded 11 (6.5%) with missing follow-up]. In the final sample of 158 patients, median age was 78.5, 62.7% female, 12.0%black, median 13 medications (IQR 8-17; 13.3% patients on benzos,22.2% opiates, 24.7% anticoagulation). Overall, 89.9% of patients were recommended PCP follow-up, with specified time frames of 1-3days (47.9%), 4-7 days (14.8%), ASAP (14.1%), and no specific timeframe (18.3%). Specialist follow-up was recommended for 33.1%(87.2% to orthopedics or hand specialists). New prescriptions were given to 35.4% (13.9% of all patients received a new opiate prescrip-tion). The overall rate of attendance at recommended PCP follow-up was 28.1%. Only 10.3% of patients who were recommended PCPfollow-up within 3 days attended in that timeframe. Overall, 24.1% attended follow-up within 1 week, 51.9% within 30 days, and 75.3%within 90 days of ED discharge; 37.3% revisited the ED within 90 daysof the index discharge (23.7% of patients with 7-day PCP follow-upand 41.7% without 7-day PCP follow-up, p=0.046). DISCUSSION: A minority of patients discharged after a fallattended outpatient ED follow-up visits in the timeframe recom -mended by the ED provider. There was a particularly low rate of PCPvisit attendance within 3 days or less, despite nearly half of patients receiving this recommended follow-up interval. Further research is needed to understand optimal recommendations for follow-up as well as solutions to fill care gaps after ED discharge.

Volume

73

First Page

S363

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