Fall Risk Assessment Before Discharge
Yes, perform a fall risk assessment before discharge even in patients whose acute symptoms (pain, neurological deficits, headache, nausea, vomiting, dizziness) have resolved.
Rationale
The absence of acute symptoms does not eliminate fall risk. Multiple validated risk factors exist independently of the presenting complaint's resolution, and fall risk assessment is a standard component of safe discharge planning.
Key Risk Factors to Assess
Based on systematic review evidence, evaluate these specific predictors 1:
- Gait instability - Test actual walking ability, not just patient report
- Agitated confusion or cognitive impairment - Even mild deficits increase risk
- Urinary incontinence or frequency - Toileting needs are a major fall trigger 2, 3
- Falls history - Prior falls are the strongest predictor
- Medication review - Particularly sedatives, hypnotics, and polypharmacy 4
Functional Assessment Components
Evaluate these specific functional domains 2, 3:
- Toileting ability - Patients with any toileting deficits have 2.86 times higher risk of readmission for falls
- Transfer ability - Bed, tub/shower transfers
- Gait evaluation - Patients needing minimal assistance during gait have 4.66 times higher fall risk
- Mobility aids - Document current assistive device use
Critical Discharge Considerations
Patients requiring skilled nursing facility placement (rather than home discharge) have 3.06 times higher fall risk 3. This suggests that even "improved" patients may have residual functional deficits warranting structured assessment.
Practical Implementation
The discharge assessment should include 5:
- Stable vital signs confirmation
- Ability to stand and walk unaided (or with appropriate assistive device)
- Structured discharge checklist documenting fall risk factors
- Patient education on specific identified risks
- Outpatient therapy referral when indicated (occupational therapy referral decreases fall risk with OR 0.26) 3
Important Caveat
Pre-discharge home assessment by occupational therapy reduces post-discharge falls by 60% (OR 2.6 for those NOT receiving assessment) 6. For patients with identified risk factors, arrange this evaluation before discharge rather than assuming symptom resolution equals safety.
The evidence consistently shows that fall risk assessment tools with sensitivity and specificity exceeding 70% exist and should be used routinely 1. Discharge readiness is not merely "street fit" but requires documented assessment of fall-specific risk factors 5.