Document Detail


Improving Internal Medicine Residents' Falls Assessment and Evaluation: An Interdisciplinary, Multistrategy Program.
MedLine Citation:
PMID:  21883104     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Falls are a major problem in older adults, and physicians receive inadequate training in falls evaluation. A multicomponent program (lecture, academic detailing, and case studies) was implemented to enhance medical residents' knowledge, skills, decisions, and interventions made about falls as part of a larger project to improve assessment and care of older adults. Electronic medical record (EMR) template modifications provided cues and reminders, decision support, and documentation into the visit note. Nursing staff and the EMR prompted residents to evaluate patients with a history of falls. Knowledge and confidence were assessed using a pre- and postintervention questionnaire, and an attending physician assessed skills by direct observation of the Timed Up and Go Test (TUG). Effect on clinical actions was assessed using the EMR database. Participation in training of faculty and staff was high. Over the 3-month intervention period, an attending physician reviewed the detailing sheet outlining important points of the training with 86% of residents, and 64% demonstrated a TUG to an attending physician. Of 895 older adults seen, 15% (134) had a positive screen for falls, of whom 92% (123) had an EMR falls template completed, and 42% (56) had a TUG performed. Of the patients evaluated with the TUG, 53% (29) failed. A review of charts for patients who failed the screen or TUG revealed that the majority had special circumstances limiting their participation, even after a physical therapy evaluation. Education and system changes facilitated improvements in resident knowledge, skill, self-efficacy, and clinical action in screening, evaluating, and managing falls in older adults.
Authors:
Cathryn Caton; M Kathleen Wiley; Yumin Zhao; William P Moran; Jane Zapka
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-24
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  -     ISSN:  1532-5415     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-9-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
Affiliation:
Division General Internal Medicine and Geriatrics Department of Medicine College of Medicine Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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