The trauma centre that started asking how far the patient fell

The Rees-Jones Trauma Center at Parkland Memorial Hospital in Dallas is a
Level 1 trauma centre. In 2012 it integrated components of STEADI —
the CDC's older adult fall prevention initiative — into its own programme, over
two years.

A trauma centre treats the broken hip. STEADI asks what caused the fall, and
whether the next one can be prevented before the patient leaves.

What they actually did

Screened all older adults for falls, and recorded the fall itself. The
centre built an **injury flowsheet into each patient's electronic health
record**, collecting data on every older adult admitted and, for those who had
fallen, details of the fall — where it happened, and **the approximate
height they fell from**.

That is the unusual step. A hospital record normally documents the injury. This
one documents the event, which is what makes identifying hazards and
preventing the next fall possible at all.

Evaluated gait, strength and balance. Every patient at risk of a future
fall had a functional assessment, and the results decided whether **vision
care or physical therapy** were needed before discharge — not referred
onward afterwards.

Conducted focused physical exams on arrival and again after admission. Each
patient was also evaluated by a mental health specialist, to assess the
need for behavioural or alcohol- and drug-related intervention.

Assessed and managed postural hypotension — dizzy spells — with the cause
evaluated and addressed by the medical team.

The multidisciplinary part

The team included **trauma surgeons, primary care physicians, trauma nurse
clinicians, geriatricians, physical, occupational and speech therapists,
pharmacists, and community health paramedics**.

Pharmacists and community health paramedics are the two that a trauma service
would not normally include, and they map directly onto two of the largest
modifiable causes of falls: medication, and **the home the patient is
going back to**.

Source: Centers for Disease Control and Prevention, STEADI.