Objective: We sought to determine the rate and challenges to follow-up with a fall prevention program after an Emergency Department (ED) based referral. Methods:We conducted a mixed-methods study of a pilot ED falls referral program. Older (≥ 65) patients who presented to the ED with fall-related injury were enrolled. We held semi-structured interviews in the ED and referred fall patients to an outpatient fall prevention program. We assessed quantitative outcomes, including 6-month mortality and recurrence of falls, and conducted follow-up phone interviews.Results: One hundred geriatric patients patients were enrolled and 22 were referred. None (0%) participated in the program. After 6 months, the mortality rate was 8.5% and 28% of the patients had recurrent falls. Qualitative data revealed that challenges to fall prevention were 1) practical considerations, 2) competing health issues, and 3) perceptions of fall risk. Conclusion:None of our patients followed up in an outpatient falls program. Our patients had a high rate of recurrent falls. Follow-up interviews revealed that ED referral alone is not enough to overcome challenges to participation in a fall prevention clinic. Actively addressing barriers to fall clinic follow-up is necessary to improve outpatient fall clinic show rates.