The problem

Fall-related injuries are one of the leading reasons for emergency department (ED) visits, particularly among older adults. Those with injurious falls tend to experience greater adverse health outcomes such as hospitalization or recurrent ED visits. As an LHS scholar, I collaborated with a multidisciplinary ED and Rehabilitation team at Intermountain Health to develop a quality improvement (QI) initiative aimed at addressing a system-identified priority related to improving falls risk screening in the ED. During the development phase, our team and our ED partners discussed questions related to the feasibility and potential success of the QI initiative in the ED, including its impact on workflow, clinician burden, potential barriers and resources required.

The solution

To systematically address these concerns, we developed a set of research questions that would support the QI initiative. The final agreed upon research aims were to: 1) assess acceptability, feasibility, barriers and facilitators of implementing falls risk assessment in the ED; 2) develop a formal evaluation plan to assess the implementation process; and 3) identify high-risk groups that should be prioritized for falls risk assessment.

The process

We used an iterative process to identify, prioritize, and finalize the research aims. Our team met weekly over the course of a year to develop the QI initiative and associated research aims. Decisions were made based on group consensus. Discussion among team members during these team meetings highlighted key themes related to the selection of falls risk screening tools, intervention options for those at risk for falls, and evaluation of the implementation and success of the QI initiative. We conducted a literature review and prioritized research questions based on evidence gaps, direct and immediate relevance to the QI initiative, and feasibility of being answered in a timely manner. We decided as a team that focusing on evaluating how the falls risk assessment process was being implemented in the ED would be most beneficial for the QI initiative. To guide the framing of our final research aim and study design, we used implementation science principles and two implementation science frameworks: the CFIR (Consolidated Framework for Implementation Research) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework.