Older fallers presenting to the ED consume significant healthcare resources and are an easily identifiable high-risk population. They may benefit from systematic fall-risk assessment and tailored fall-prevention interventions.

A simple, two-item screening tool demonstrated good external validity and accurately discriminated between fallers and non-fallers. This tool could identify high risk individuals who may benefit from onward referral or intervention after ED discharge.

Background: There is strong evidence indicating the risk of refracture following an osteoporotic or minimal trauma fracture (MTF) is high. However, multiple national and international studies have highlighted the low rates of screening for bone fragility and treatment initiation among people presenting with MTF. Against this background and in response to the South Eastern Sydney _Local Health District (SESLHD) Falls Injury Prevention Plan 2013-2018_, Brake the Break (BtB), a community based partnership providing the first osteoporotic refracture prevention (ORP) service in metropolitan New South Wales (NSW) was established in May 2014. This service provides a significant addition to traditional referral pathways for these patients. The BtB service aims to reduce refractures in this patient cohort with MTF. The objectives are to increase the level of early identification and initiation of treatment in patients with osteoporosis. Method/Design: The BtB service, available to residents of the St George local government area of South Eastern Sydney, is based on the NSW Agency of Clinical Innovation Model of Care for Osteoporotic Refracture Prevention. A dedicated fracture liaison coordinator who identifies eligible patients and has responsibility for case management is central to this model. Identification of patients aged over 50 years with a recent MTF occurs via the Emergency Department (ED) admission records of St George Hospital, a major tertiary teaching hospital or through primary health care providers in SESLHD. Eligible patients are those who presented to the St George Hospital Emergency Department, primary health care providers and other health and community services. The Service is offered at two locations. The community based model of care, integrates the District's population health and World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. Discussion: This project aims to assess the efficacy of an integrated community based Osteoporosis Refracture Prevention. Preliminary outcome data will be presented.

The aim of this study was to examine the strength of improvement recommendations proposed after investigation of fall incidents in health care facilities that result in major injuries.Methods: This study was conducted using a retrospective multi-incident analysis design. The study setting was 4 tertiary teaching hospitals, 1 subacute rehabilitation facility, and a residential aged care facility in a metropolitan health district in New South Wales, Australia. Ninety-eight injurious fall incidents during a 2-year period (2015-2016) were investigated. Recommendations were grouped into 3 categories: strong (including environmental modifications, equipment, workflow or process redesign), medium (including changes in communication or documentation processes, staffing numbers and/or skill mix, education to address identified knowledge deficits), and weak (including alerts/warning/labels or expected practice without any associated policy or procedure). Results:The majority of the incidents (34.7%; n = 34) occurred between 1300 and 1859 hours, 65.3% (n = 64) occurred in the patient's room, and 79.4% (n = 81) of the injuries were fractures. There were 224 recommendations made for 79 incidents, and 19 incidents did not have any recommendations. The average number of improvement recommendations proposed per incident investigation was 2.3 (SD, 2.1; range, 0-9). Nineteen (8.5%), 80 (35.7%), and 125 (55.8%) recommendations were classified as strong, medium, and weak, respectively. Half of the investigative teams included representatives from more than one professional group. There were a significantly greater number of medium recommendations made by multi-disciplinary teams compared with single-disciplinary teams (odds ratio, 1.83; 95% confidence interval, 1.05-3.21). There was no significant difference in the number of strong and weak recommendations made between the 2 teams.Conclusions: This study found that only 8.5% of recommendations were classified as strong. This suggests that a major challenge lies in formulating robust recommendations; hence, efforts should focus on enhancing the strength of improvement recommendations.

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