Falls for the Inpatient Physician: Translating Knowledge Into Action
University of Colorado School of Medicine
A small group, preceptor-mediated, Power-Point guided workshop on evaluation and management of geriatric falls for the inpatient physician. It is based on the philosophy that the hospital physician must be able to integrate the unique interaction between the physiology of the aging body and the inter-current illness in the context of the hospital system of care delivery. It is designed to guide students through a practical process for evaluating and acting on risk factors for future falls in the elderly patient and to evaluate and mitigate the risk for falls during hospitalization. A central emphasis of this module is that knowledge about risk factors for falls is insufficient if this is not paired with concrete actions taken by the hospital physician. The module explores barriers to effective modification of contributors to the multi-factoral geriatric syndrome including “possibility paralysis” and institutional communication silos. The module trains the student to focus on a limited set of modifiable risk factors and to translate knowledge into definable orders to decrease the risk of falls. The emphasis is on systems-based practice improvement rather than solely individual practitioner knowledge. It was developed for the Hospitalist Training Track internal medicine residents at the University of Colorado Hospital rotating on the Hospitalist Acute Care for the Elderly service, and is designed for small groups of 1-8 students. Content level is appropriate for 3rdand 4thyear medical students and internal medicine/family practice housestaff. The entire module requires approximately 1 hour.
The learner will be able to:
- Recognize the societal and personal adverse impact of the geriatric fall.
- Recognize the barriers to taking effective action for a multi-factoral geriatric syndrome.
- Understand risk factors for falls in the context of the interaction between the postural challenges of aging, medical co-morbidity/medications, and behavioral factors which, when combined with an environmental trigger and underlying physiologic frailty, combine to create a injurious fall.
- Understand how physicians can improve their own fall risk assessment
- Learn about the hospital system and how non-physician providers assess and attempt to reduce fall risk for hospitalized elderly patients. To critically examine how the physician operates within this hospital system and what actions on the level of the individual physician and system changes can be taken to reduce risk of in-patient falls.