From framework to frontline: Embedding enterprise risk management into emergency department fall prevention

This letter to the editor responds to Bailey and Delchamps' recent article on integrating enterprise risk management (ERM) in fall-related injury prevention. We extend their framework to emergency departments (EDs), emphasizing the strategic advantage of initiating individualized fall risk assessment at the point of triage. Many high-risk indicators-such as anticoagulant use and cognitive impairment-are already accessible in ED settings and can be embedded into machine learning-supported tools like the Rothman index or fall triage score. We also highlight the financial implications of fall-related injuries originating in or near the ED, noting their potential to increase hospital length of stay and trigger non-reimbursable costs. The authors' inclusion of risk matrices and heat maps presents scalable opportunities for safety prioritization in dynamic ED environments. We conclude by recommending prospective validation of ERM-based approaches within level 1 trauma centers and invite collaboration to test the framework's effectiveness in real-world emergency settings.