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 ?