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. 2025 Jan;73(1):232-242.
doi: 10.1111/jgs.19080. Epub 2024 Jul 9.

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data

Lynn G Jiang  1 , Christina McGinnis  2 , Emily Benton  1 , Emilee Nawa  1 , Michael Stern  1 , Wenna Xi  2 , Rahul Sharma  1 , Brock Daniels  1   2
Affiliations

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data

Lynn G Jiang et al. J Am Geriatr Soc. 2025 Jan.

Abstract

Background: Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge.

Methods: High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals.

Results: Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall.

Conclusions: A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

Keywords: STEADI; community paramedicine; emergency medicine; high‐risk fall reduction; mobile integrated health.

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Conflict of interest statement

Conflict of Interest Statement

Brock Daniels, MD MPH is a consultant for and holds equity in ivee (New York, NY). This company was not involved in the funding, design, conduct, analysis or reporting of this research project.

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