Dundee Falls Project
Paul Moran
Feb 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 Coordinator 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
Dundee Falls Pathway – Current State
Patient
Falls
Ambulance
A&E
Community
Alarm
Warden
See and treat
Fracture clinic
Medical
wards
Orthopaedics
Home
RVH Falls Clinic
GP
CRT
District
Nurse
Psychiatry,
Specialist
Service
Key
Blue – Health
Yellow – Social Work
First
Contact
Team
Discharge
Pharmacy
Care
Manager,
Social Work
If has active worker
Community support,
Home Care/Enablement/Care Home
Dundee Falls Pathway – Future Pathway
Older Person Falls
A&E
Ambulance
Hospital
In-patient
GP/Self/Carer
Fracture Clinic
Falls causing concerns:
•Community Nurse
•Community AHP
•Care Worker
•Community Alarm
•Sheltered Housing Warden
•Care Home Staff
Single Point of Access
To Falls Service
Triage / Sign-posting
RVH Falls Clinic
Exercise Options
OTAGO Community classes
Professional/Agency referral
•Physiotherapy
•Occupational Therapy
•Podiatry
•Pharmacy
•Care and Repair
•Care Management
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
Date
21/01/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
03/12/2012
26/11/2012
19/11/2012
12/11/2012
05/11/2012
29/10/2012
22/10/2012
Number
Attendances Trend
Number of Attendances compared with Falls
50
45
40
35
30
25
Total Number of Over 65s
20
Total Falls
15
10
5
0
Outcome of Triage
Outcome Following Triage
120
107
101
100
80
72
60
43
40
20
0
15
0
Falls Clinic
7
1
0
Community
Falls Class
11
Physio
OT
5
0
GP
District
Nurse
S/W OT
Podiatry
0
Care &
Repair
0
Pharmacy
Community
Alarm
Falls Pack
None
Required
Other
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 ?