A Quick TUG to Prevent Older Adult Falls in the Emergency Department

Preventing falls in acute care settings has been a topic of regulatory and quality improvement discussions for decades. Older adults are particularly at risk for fall related morbidity and mortality. Many emergency departments (ED) have implemented the Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT) which is a questionnaire screening for falls. With a rapidly aging population in the United States, professional organizations recommend using an assessment approach with implementation of the Timed Up and Go (TUG) mobility screening. The TUG assessment was implemented in an urban ED for 22 days yielding 243 mobility screening results. All adults over 65 years of age without exclusionary criteria were assessed to determine degree of frailty in an acute care setting. An assessment time of greater than 12 seconds is considered positive and prompts the ED provider to place a referral to the patient’s primary care physician for an outpatient physical therapy assessment. One in five of adults screened received outpatient physical therapy referrals. Data analysis finds very little correlation between the MEDFRAT and TUG results. Approximately 15 percent of patients scoring zero and 40 percent scoring low on the MEDFRAT were found to be a fall risk by the TUG mobility assessment. This project demonstrates the importance of an interdisciplinary mobility assessment approach to reducing costs, loss of independence, and mortality related to falls in our older adult population. The recommendation is to favor mobility assessments over verbal questionnaires to prevent falls and promote outpatient therapies in this population.