A Clinical Audit of Staff Compliance With Local, National & International Guidelines Regarding Falls Assessment in The Geriatric Emergency Medicine Unit

Abstract Background Falls are the leading cause of Emergency Department (ED) visits in adults aged 65 and over (Stoeckle et al., 2019). They present a significant healthcare challenge, with up to 33% requiring hospital admission (Choi et al., 2019). Timely falls risk assessment in the ED is essential to guide interventions and reduce further morbidity. Methods A clinical audit was conducted on 20 medical charts of patients who attended the Geriatric Emergency Medicine Unit (GEM-U) with a fall as their index presentation in Q4 2023. Re-audits were completed in Q2 2024 and Q1 2025. To ensure a representative sample, Manchester Triage System categories included “falls,” “limb problems,” “collapse,” and “back pain.” An audit tool comprising 11 standards was developed, informed by the World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative (2022) and the European Society of Cardiology Guidelines for the Diagnosis and Management of Syncope (2018). Results were analysed using descriptive statistics. Results In the initial audit cycle, compliance varied across all 11 standards ranging from 15-100%. A number of clinical practice improvements were implemented including team-based education on assessment practices and introduction of a "falls from a standing height checklist" informed by Major Trauma Audit. Composite compliance increased from 65% in cycle 1 to 90% in cycle 3. Cycle 2 and 3 results showed a composite increase in compliance in the areas of: careful history taking (55%-100%), completion of an electrocardiograph (60%-90%) and completion of lying & standing blood pressure (25%-65%). Conclusion This audit identified key areas for team-based clinical practice development, supported by the implementation of a structured quality improvement plan. Improvements in compliance across multiple assessment standards highlight the impact of targeted education and documentation tools. Future efforts should prioritise sustaining these improvements and exploring further evidence-based interventions to enhance falls assessment and prevention in the ED.