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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: [email protected]
Any Questions ?