New Protocol Leads to 62.9% Drop in Fall-Related ER Visits

Assisted living providers who facilitate communication between paramedics and primary care physicians can prevent a trip to the hospital for many of their residents who fall, according to a new study published in the Annals of Internal Medicine.

The researchers studied 953 residents at 22 assisted living communities in Wake County, North Carolina, over 43 months.

Of the 953 residents included in the study, 359 of them suffered 840 ground-level falls, but not all of them went to the hospital. Using a communication protocol that included paramedics consulting with primary care physicians over the telephone, it was determined that many of those cases didn’t require an emergency room visit.


The protocol—developed as a collaboration between Doctors Making Housecalls, a group of primary care physicians specializing in home care for older adults, and Wake County Emergency Medical Services—aimed to identify residents who should not be transported to the emergency room, but instead should schedule a visit with a primary care provider within 18 hours of the incident.

Overall, implementation of the protocol resulted in a 62.9% decrease in fall-related transports, the researchers found.

That’s important, because when a resident of a senior living community falls, it usually triggers a procedural chain of events that often ends with a costly trip to the emergency room, even if the resident wasn’t seriously ill or injured. Cutting down on those emergency visits could be a “win win” for senior living providers, physicians and EMS workers, according to Dr. Jefferson Williams, who co-authored the study.


“I think the biggest thing is to be open to dialogue with your physician groups that are caring for the residents in your facilities, and local EMS,” Williams told Senior Housing News. “Everyone wants safe, appropriate care for their residents and patients, and I think the point is that solutions can be implemented that do not simply involve transport every time to the emergency department.”

Cost is another big factor associated with why more providers should examine their policies related to resident falls. If implemented at more senior living communities across the U.S., thousands of residents could avoid trips to the ER, saving money across the health care spectrum in the process.

“Part of that cost savings is EMS reimbursement reform,” Williams said. “Allowing a wider range of reimbursement policy in the EMS and prehospital environment supports patient-centered, out of hospital care, [which is] care that can take place in the home [or] in the assisted living facility.”

The program also has the potential to scale to more communities throughout the country. Key components of creating such a program include an EMS system willing to consider a non-transport protocol, a primary care group willing to take phone calls from paramedics around the clock, and that group’s willingness to see its patients on a next-day basis.

“We certainly have a unique setup in Wake County… perhaps limiting generalizability of our specific protocol,” Williams said. “But that is not to say that a very similar arrangement, with the key components I mentioned, could not be implemented in most communities in the U.S.”

Written by Tim Regan

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