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Barriers and enablers that influence guideline-based care of geriatric fall patients presenting to the emergency department
  1. Adam Parks1,
  2. Debra Eagles1,2,
  3. Yipeng Ge3,
  4. Ian G Stiell1,
  5. Warren J Cheung1
  1. 1 Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Adam Parks, Department of Emergency Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada; adparks{at}


Background Geriatric patients commonly present to the ED after a fall. Recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric fall guidelines. This study applied a theoretical domains framework (TDF) approach to systematically investigate barriers and enablers in the provision of guideline-based care to ED geriatric fall patients.

Methods From June to September 2017, semistructured interviews of staff ED physicians practising in Ontario, Canada, were conducted and analysed. An interview guide based on the TDF was used to capture 14 domains influencing provision of guideline-based care. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs and evidence of strong beliefs that would influence provision of guideline-based care.

Results Eleven interviews were conducted with practising ED physicians. Thirty belief statements were identified across 13 relevant TDF domains (all except Optimism). Prominent themes included lack of knowledge, paucity of evidence, heterogeneous self-perceived skills, perceived increased time and workload, importance of allied health support, inconsistently available allied health workers, lack of positive reinforcement, emotions negatively impacting these clinical encounters and support for memory aids. Overall, ED physicians were supportive of guideline implementation, and believe it will lead to better outcomes for geriatric fall patients.

Conclusion This study identified important barriers and enablers to provision of guideline-based care in geriatric ED fall patients. Based on these findings, future implementation of guidelines nationally and internationally should focus on improving knowledge and training on guidelines, improving positive reinforcement for guideline-appropriate management, greater allied health support and further research to support guidelines.

  • geriatrics
  • emergency department
  • Trauma

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  • Contributors AP conceived the idea, collected the data and prepared the manuscript. DE and WJC provided considerable assistance in study design and statistics, and revised the manuscript. YG collected data and revised the manuscript. IGS provided considerable statistical assistance, input on study design and revision of the manuscript. AP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for this study was obtained from the Ottawa Health Sciences Network Research Ethics Board prior to commencement (Protocol No 20170152-01H).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Press release Yes.