Dundee Falls Project

Paul MoranFeb 2013

Today’s Presentation

• Background information

• What is a Fall

• Falls statistics

• Projects

• Pathways

• Ninewells Accident and Emergency Pilot

• DIAL – OP involvement

Who I am

• Physiotherapist with CRT

• Working as Dundee’s Falls Co-ordinator since 1st August 2012

• Aim

– Develop a Falls Pathway– Promote Exercise/Falls Prevention

Falls

“A Fall is a symptom, not a diagnosis”

The causes of Falls can be:

• Extrinsic: e.g. trips and environmental hazards

• Intrinsic: e.g. muscle weakness, loss of balance, impaired vision, medication related

• Combination of both

Each fall is significant – a person who has fallen once is more likely to fall again!

Falls Statistics

Falls are a significant cause of hospital admissions

• In the UK

– Fracture hip every 10 minutes

– Fracture spine every 3 minutes

– Fracture wrist every 5 minutes

• Significantly, over 40% of those who fall reduce their activity due to fear of further falls

• On average 50% of all falls occur in the persons own home

• It is estimate that 75% of falls are NOT reported

Dundee Statistics

In Dundee, on an annual basis

• 30% of >65 years will fall (approx 8,000 people)

• There were over 7,800 A&E admissions to Ninewells in 2011 as a result of a fall

– 22 per day

• 999 calls for Falls in Tayside (approx 3,600)

Projects

• Investigate Dundee’s current pathway

• Stakeholder event

• Test of Change

– Accident and Emergency– Social Care Response– Falls Clinic referrals– Single Point of Access

• Community Falls Prevention classes

– OTAGO training

Patient Falls

Ambulance Community Alarm

WardenA&E

DischargeFracture clinic

Medical wards

Orthopaedics Home

RVH Falls Clinic GP

CRT District Nurse

First Contact Team

Psychiatry, Specialist Service

Pharmacy Care

Manager, Social Work

Community support, Home Care/Enablement/Care Home

Key Blue – Health

Yellow – Social Work

If has active worker

Dundee Falls Pathway – Current State

See and treat

Dundee Falls Pathway – Future Pathway

Older Person Falls

A&E Ambulance

Fracture ClinicHospital In-patient

GP/Self/Carer Falls causing concerns:•Community Nurse•Community AHP•Care Worker•Community Alarm•Sheltered Housing Warden•Care Home Staff

Single Point of AccessTo Falls Service

Triage / Sign-posting

RVH Falls Clinic

Professional/Agency referral•Physiotherapy•Occupational Therapy•Podiatry•Pharmacy•Care and Repair•Care Management

Exercise Options

OTAGO Community classes C.A.N. Exercise database

A&E Pilot Background

• In 2011, there were 7868 attendances at A&E as a result of a fall

• On average, this is 21.6 per day

• In 2011, 7031 of these attendances were discharged home following assessment at A&E

• In 2011, over 65’s accounted for 52% of these attendances

Month 2009 2010 2011

Jan 551 586 787

Feb 548 501 498

Mar 715 587 648

Apr 668 540 653

May 687 692 735

Jun 693 642 650

Jul 625 631 610

Aug 629 621 675

Sep 632 629 677

Oct 558 576 634

Nov 529 545 545

Dec 566 727 756

Total 7401 7277 7868

Number of Attendances compared with Falls

0

5

10

15

20

25

30

35

40

45

50

22/1

0/20

12

29/1

0/20

12

05/1

1/20

12

12/1

1/20

12

19/1

1/20

12

26/1

1/20

12

03/1

2/20

12

10/1

2/20

12

17/1

2/20

12

24/1

2/20

12

31/1

2/20

12

07/0

1/20

13

14/0

1/20

13

21/0

1/20

13

Date

Nu

mb

er Total Number of Over 65s

Total Falls

Attendances Trend

Outcome of Triage

0 0

43

1

1511

70 0

50

107101

72

0

20

40

60

80

100

120

Falls Clinic CommunityFalls Class

Physio OT GP DistrictNurse

S/W OT Podiatry Care &Repair

Pharmacy CommunityAlarm

Falls Pack NoneRequired

Other

Outcome Following Triage

Outcome of Triage

• Approximately a third of patients telephone triaged did not require any further follow up

• Approximately a third were sent a Falls pack for further information

• 43 were referred to physiotherapy either at Kings Cross as an outpatient, or CRT

• 15 were advised to contact their GP’s with a view of further investigation

– These 15 would possibly have been considered for referral to RVH Falls Clinic

• A low number were referred to locality Pharmacists due to difficulties identifying appropriate patients

– 4 or more medications Vs. Combinations of medications

Breakdown of “Other” outcome

• During the screening process 24% were already known to a service

• Due to initial problems checking MiDIS and Social Work Database (K2), it would be expected that a greater number may have been known to these services.

“Other” Number

Day hospital 8

Parkinson’s clinic

5

Physiotherapy 22

Care Manager 11

Admitted 6

Repeat 4

District nurse 10

No consent 1

Audiology/ENT 1

Liff 1

PICU 1

Deceased 1

Falls clinic referral

1

DIAL – OP Involvement

• Back to original aim:

– “Promote exercise and Falls prevention

• Falls Pack– DIAL-OP card– Falls leaflet– Self referral form for Physiotherapy

• New Falls “Magazine” – Information on services– Referral forms– Adverts

DIAL – OP Involvement

• Signposting– If a person has fallen direct to Single

Point of access• Triage referral: Will make onward referral to

appropriate service such as physiotherapy, OT, social care response, social work OT, district nurse, poly-pharmacy review”

– If the person is simply looking for community exercise, please direct via the database of community exercises

Contact Information

Single Point of Access is currently based at Royal Victoria Hospital

• Mail: Early Intervention Hub, Royal Victoria Hospital, Jedburgh Road, Dundee, DD2 1SP

• Email: dundeefallsreferral@nhs.net

Any Questions ?