South Tyneside NHS Foundation Trust The Community Falls Service: How we made it better

Our Format Wasn’t Working The old format of this clinic had nurses assess for the need for physio as well as other services. Very limited access to regular physio intervention. – Patient underwent numerous different assessments – Poor inter-disciplinary collaboration – Questionable outcomes for patients with continued risk of falling – Lack of structure to exercise programme

Searching for Another Way Several other clinics, each compliant with NICE guidelines for Fall Prevention were visited. Observations: – interdisciplinary working – good and bad – Poor quality of information from numerous different assessments – Patient exhaustion from over assessment – Further delay in intervention from over assessment – Services generated referrals onward rather than interventions for the patient

Our plan One concurrent assessment by physiotherapists and nurses working jointly. Patients to be fully assessed with some intervention supplied in a 90 minute time slot. Stock of walking devices retained on site to provide patients with at point of assessment On site, regular access to progressive exercise programmes with patients having their next appointment scheduled prior to leaving the assessment.

Why is Concurrent Assessment Advantageous? 61% of participants had more than 1 factor contributing to their falls. Having joint interdisciplinary assessments ensures no single factor gets overlooked.

Our Goals Improve the patient journey and reduce risk with swifter assessments flowing into regular exercise interventions and immediate access to mobility aids. Improve patient safety and outcomes with fewer chances at lost information and improved collaboration. Involve all providers, in the assessment. Demonstrate a real reduction in falls in this at-risk population.

Challenges Nurses and physios assessing side by side threatened roles and responsibilities Management understanding the benefit of longer assessment times in exchange of more numerous, shorter assessments Other providers giving input into the process e.g. transport drivers and HCA staff. Making the service truly patient centred and not defined by discipline or diagnosis.

So what did we do? P = Plan D = Do S = Study A = Act

The Audit After one year, did we accomplish what we set out to do? – 142 people completed a course of interventions – Objective measures captured at discharge e.g. Timed Up and Go – Contacted again 6 months post discharge – Did they have further falls?

The Results Total Number of Falls 6 months pre and 6 months post clinic A decrease of 512 falls ( 81% reduction ) amongst 142 patients

The Results 140 people had fallen prior to interventions from the service. Of those 140; 98 people had zero falls 6 months after discharge from the service

The Response “Caring manner and explaining why they are doing things - involving us all - helps us make sure we are getting the care we need.” Quote from a patient

The Future Sunderland’s over 65 population to grow by 20% by 2020 ( Preserving resources by preventing falls – 512 falls prevented – 512 Ambulance call outs prevented £117,760 – 26 Hip Fractures Prevented £149,344 – 13 Care Home Admissions Prevented £318,396

On to South Tyneside! A similar assessment service has been established here in South Tyneside as of March Monitoring of patient response has started with the Friends and Family project in January 2015 Monitoring of clinical outcomes will begin once follow up physiotherapy services are solidified.