A Pilot Fall Prevention Program Using "STRATIFY" at Triage of Emergency Department in Hong Kong

A fall is an event which results in a person coming to rest unwittingly on the floor or ground or other lower level. Those who have fall history have significantly more hospitalizations and clinical visits as well as emergency department visits than those who do not. Loss of confidence in walking, fear of falling, social isolation and depression can also occur in those patients. Fall is a predictor for decreased functional status and risk factor for the whole institution Approximately 30% to 40% of people aged 65 years and older who lived in the community fall each year. Multiple studies related to falls have shown a close relation between sex and age. As a result, Elderlies who are prone to falling consume more health care resources than non-fallers.

STRATIFY proved to be more accurate and more frequently utilized. STRATIFY was originally derived in mixed acute/rehabilitation geriatric wards of UK urban teaching hospital using a 'case control' design and multi-variate regression to identify predictors of falls in hospital inpatients. This resulted in a simple five-point score (each item scoring 1 or 0), with predictive "cut-offs" as 2 or 3 used in the original validation studies which followed. STRATIFY was not designed or validated for continuous modelling of risk but for use in categorical prediction 'high' versus 'low risk'. Sensitivity and specificity were both found to be in excess of 80% in the two UK cohort of the original paper, leading to wide spread adoption of the tool in clinical practice. It is now ten years since the publication of the original STRATIFY paper and a number of prospective studies in several cohort of patients have been published.

Objective and Propose

1. To assess the effectiveness of the fall preventing intervention after targeted group is screened by the tool "STRATIFY" in triage
2. To look at the discrepancy of fall perception of patient/caregiver and the assessment result using "STRATIFY".
3. To compare the fall rate after applying the screening tool "STRATIFY" and with intervention given in their AEDs.

Hypothesis

1. It is hypothesized that the effectiveness score collected from patient and/or caregivers via questionnaires within data collection period shows positive result and these measures are worth to execute in A&E.
2. It is hypothesized that there may not be a big discrepancy of fall perception of caregivers with the result of assessment tool and there is a discrepancy of fall perception of fall perception of patients as they may over-estimate their ability
3. It is hypothesized that the fall rate of intervention group will be lower than that of control group.

Rate of fall incident which is properly documented and reported to AIRS after using fall screening tool "STRATIFY" and intervention given will be the intervention group.

Rate of fall incident of usual practice in a designated period will be the control group.