Managing falls onsite in residential aged care homes reduced hospitalisation: Mixed methods results from the Falls Outreach and Residential Mobile Assessment Team (FORMAT) pilot study.

OBJECTIVE: Falls are the leading cause of hospital transfer from residential aged care homes (RACHs). However, many falls do not result in significant injury, and ageing patients are exposed to complications while hospitalised. Inreach services are designed to reduce hospital transfer by providing care, support and assessment to residents at the RACH. This study evaluated a pilot inreach program targeting ageing patients following a fall. METHODS: We conducted a prospective, mixed methods evaluation of a 5-month (May-September 2022) pilot implementation across 108 government-funded RACHs within a single health-care network in Melbourne, Australia. RESULTS: A total of 123 residents (median [interquartile range] age: 88 [82, 94] years, female: 49%) were included in the intervention. The majority (n = 116, 94%) of residents were managed onsite and required no further investigation (n = 80, 69%) or treatment (n = 63, 54%). Among the seven residents referred to the emergency department (ED), two received hospital admission and five were transferred back to residential care. In the 7 days following referral to the intervention, four additional residents were referred to the ED and one received hospital admission. Qualitative feedback (n = 40) included specific comments relating to themes of general satisfaction (n = 20, 50%), compliments for staff (n = 16, 40%) and acknowledgement of comprehensiveness (n = 9, 23%). CONCLUSIONS: Implementation of a specialised fall assessment team to complement an existing geriatric-led RACH assessment service meant that a high rate of eligible residents were managed onsite, with very low need for subsequent hospitalisation. Residents, family members and caregivers expressed high rates of satisfaction with the service.

Child maltreatment prevention: a content analysis of European national policies.

Background: Child maltreatment is a major public health concern, which worsens inequalities and perpetuates social injustice through its far-reaching impacts on the health and development of children affected. The aim of this article was to provide a content analysis of the national policies presently used to address child maltreatment and provide an overview of prevention practices being employed in countries of the World Health Organization (WHO) European Region. This analysis will aid in identifying, which policy areas still require further work to prevent child maltreatment. Methods: Three search methods were employed to identify national policies on child maltreatment. A framework based on WHO guidelines for the development of policies was used to conduct a policy analysis of the identified national policies. Results: Two hundred and seventy-eight national policies were identified; of these, 68 met the inclusion criteria for further analysis representing 75% of the WHO Europe Region Member States. Whereas the majority of policies fulfilled most of the WHO criteria for effective policy-making, only 34% had a budget and 6% had quantified objectives. Plans to implement proven child maltreatment prevention interventions were high, with the exception of some countries where the health sector is in the lead. Conclusions: The key policy areas requiring improvement were quantifiable objectives and allocated defined budgets. Hospital-based and home-based child maltreatment interventions were also not widely planned for implementation. Encouraging progress is being made on national policy development to prevent child maltreatment. There are as of yet, several key areas, which warrant increased attention in future policy-making.

Worsening Inequalities in Child Injury Deaths in the WHO European Region.

This article compares the mortality data for injuries in children aged 0-14 years in the World Health Organization WHO European region as estimated by the WHO Global Health Estimates for 2000 and 2015. While the region has seen a decline in child mortality due to injuries over the years, inequality persists between the low- and middle-income countries and high-income countries in the region. The gap in child mortality due to unintentional injuries has widened over the years between these two socioeconomic regions, particularly in terms of road injuries. In contrast, mortality rate ratios due to intentional injuries have narrowed between 2000 and 2015. The low- and middle-income countries need to scale up their efforts in injury prevention by adopting stricter regulations and higher safety practices to narrow the East-West gap in unintentional injuries.

Emergency department 'undercrowding' is associated with decreased waiting times.

OBJECTIVE: To evaluate the effect of a sudden and sustained decrease in patient presentations on waiting times and other measures of workload and flow following the opening of a large, greenfields ED adjacent to our own. METHOD: A descriptive study involving all patients presenting to a private urban district hospital ED for two 60 day periods, immediately before and after the opening of the tertiary hospital ED. Changes in median waiting time, case-mix distribution, method of arrival, total admissions and total waiting time were compared pre-opening and post-opening. Non-normally distributed variables were analysed using Mann-Whitney U-tests. Categorical variables were compared using χ(2) analyses. RESULTS: Patient presentations decreased by 28% with a parallel decline in median waiting time of 15 min (from 26 to 11 min) (P < 0.001). Total waiting time was approximately 29 h less per day in the post-opening period. Patient urgency by triage category did not change significantly (P = 0.316), whereas the proportion of presentations by ambulance decreased 15.9% (P = 0.048) and admission rate increased from 29.1% to 32.6% (P = 0.002). CONCLUSIONS: Patient presentation numbers are strongly associated with and likely impact on median waiting time. Understanding that controlling demand can lead to significant benefits in patient processing, flow and overall patient perceived level of care and satisfaction is relevant to any discussion on ED overcrowding and the deleterious effects of access block.