# An Emergency Department Virtual Observation Unit Fall Prevention Program: A Pilot Acceptability Study

## TL;DR

This study tested a new fall prevention program in an emergency department for older adults and found it acceptable and safe, though participation was low.

## Contribution

A novel multi-component fall prevention initiative embedded in an ED Virtual Observation Unit was developed and assessed for acceptability.

## Key findings

- Participants found the ED VOU Falls program comfortable and acceptable, though neutral about its effectiveness.
- VOU physicians found the program feasible and safe, with no interference in ED operations.
- At three months, no falls were reported in the intervention group, while two occurred in the control group.

## Abstract

Background

Falls are a leading cause of unintentional death among adults aged 65 and above and are associated with significant injuries and healthcare costs. Older adults frequently present to the emergency department (ED) for falls. However, ED clinicians rarely focus on preventing future falls, given the lack of time and resources. We developed a novel multi-component fall prevention initiative embedded in our ED Virtual Observation Unit (VOU) Falls program.

Methods

This feasibility study, conducted at a level-1 urban teaching hospital, assessed the program’s acceptability and safety. The program included home safety evaluations, timed up and go (TUG) tests, and telemedicine reviews of medications. Data were collected using Research Electronic Data Capture (REDCap). Patient demographic data and Charlson comorbidities were recorded. Surveys adapted from the theoretical framework of acceptability (TFA) were administered to patients and providers to assess comfort, effort, fairness, acceptability, feasibility, and safety. Follow-up surveys were conducted at three months to determine changes in fall-risk behaviors. Descriptive analyses were performed to evaluate Likert scale survey data.

Results

Ultimately, 35 patients were included, with six in the intervention group and 29 in the non-intervention group. Participants felt comfortable with the ED VOU Falls program and found it acceptable, though neutral about its effectiveness in reducing fall risk. VOU physicians (22/30, 73%) found the program fair, feasible, and safe and did not interfere with ED operations or their clinical duties. At three months, no falls were reported in the intervention group, while two (8%) patients experienced falls in the control group. A higher percentage of patients in the intervention group reported actions to reduce fall risk.

Conclusion

The ED VOU Falls program appears acceptable, feasible, and safe but has a low participation rate. Further work is needed to understand provider and patient concerns regarding participation in order to adapt the program accordingly.