The model of care delivery should be appropriate to local resources and local specialties while ensuring implementation of suggested guidelines. Models of care delivery can vary from a single one-site-one-stop falls clinic to a wider multidisciplinary practice in which several specialists (pharmacists, physical therapists, neurologists) are involved in assessment and management. Falls clinics can be single-site facilities or virtual models with mobile teams.
All key stakeholders should be involved in the earliest stages of development and implementation of the falls clinics.
Establishing a mechanism through which regular communication (eg, EMR) with all stakeholders (ie, patients, referring physicians, hospital/clinic management, consultant physicians, nurses, other allied medical professionals) is essential to ensure an ongoing consensus for and an understanding of proposed management strategies. A clear diagnostic and therapeutic pathway provides a framework, which is fundamental to seamlessly incorporate new evidence into the model.
The management strategy should be agreed on and practiced by all practitioners (encompassing a range of specialties) involved in the assessment and management of falls.
The age range and symptom characteristics of patients appropriate for fall investigation should be determined in advance. Some facilities are prepared to evaluate both younger (18–64) and older adult patients (65+), whereas others limit practice to those ≥65.
A wide age range is encouraged.
Potential referral sources should be taken into consideration. Referrals can be made directly from PCPs, the ED, subspecialists (eg, neurology, orthopedics, rheumatology, endocrinology), and inpatient hospitalists (postdischarge).
The scope of referral source has implications for resources and skill mix.
A significant amount of the work can be undertaken by clinic staff (eg, medical assistants, nurses) and advanced practice providers (PAs, nurse practitioners). This requires specific skill and competence.
In addition to assisting the falls specialist, staff can perform initial assessments and tests (under physician supervision), provided that they are based on internal protocols and rules, and staff should receive ongoing education and training in falls assessment and management.
ED, emergency department
EMR, electronic medical record
PA, physicians assistant
PCP, primary care provider