Factors Associated with Emergency Department Discharge After Falls in Residential Aged Care Facilities: A Rural Australian Observational Study

Abstract

Background: Falls are the leading cause of emergency department (ED) presentations among residential aged care facility (RACF) residents. This study identified the factors influencing the decision to discharge RACF residents from the ED following fall-related presentations. Methods: A single-centred, cross-sectional observational study was conducted in rural Shepparton, Victoria, Australia. The study included residents aged ≥65 in RACFs with fall-related ED presentations between 1 January and 19 November 2024. The main outcome was to determine factors that may prevent unwarranted ED transfers among RACF residents following falls. Statistical methods, including multivariate logistic regression, were used to examine factors associated with ED dispositions. Results: A total of 181 presentations (69.4%) were discharged, and 80 (30.6%) were admitted. The presence of an Advance Care Directive (ACD) (adjusted odds ratio [aOR] = 2.89; 95% confidence interval [CI]: 1.37–6.05) and lower triage levels (aOR = 2.69; 95% CI: 1.06–6.80) increased the odds of discharge. Major injuries (aOR = 0.20; 95% CI: 0.09–0.42) and obvious injuries (aOR = 0.24; 95% CI: 0.10–0.56) reduce discharge chances. Whether computed tomography brain scans were performed or anticoagulation therapy was used did not significantly influence ED discharge chances. Conclusion: In addition to traditional factors associated with ED discharge in post-fall patients from RACFs, an ACD was associated with increased discharge from the ED. Strengthening fall-specific advance care planning, improving ACD accessibility, and enhancing the clinical capacity of RACFs may reduce unnecessary ED transfers and better align care with residents’ goals, particularly in rural settings.