Falls Response Service: A Multidisciplinary Response to 999 Falls

Purpose

The Falls Response Service (FRS) is a collaboration between Aneurin Bevan University Health Board (ABUHB) and the Welsh Ambulance Services Trust (WAST).

Falls have a devastating effect on frail people and account for 10% of 999 calls received by WAST. High rates of conveyance (72%) to Emergency Departments (ED) were identified. Many patients identified with ´complex´ fallers are conveyed despite no acute injury, due to a lack of appropriate support to remain home safely. Those remaining at home present with high re-contact rates following further falls.

A trial in 2015 aimed to improve outcomes by pairing a paramedic with a patient transport assistant to respond to falls. Service evaluation identified the need for specialist falls assessment, provision of basic equipment and appropriate referral pathways to local services.

79% of FRS patients
remained at home, compared to 35% of falls attended by non-FRS crews.
Only 37% of patients
who remained at home attended hospital within a month...

...While it has not been possible to compare this to the core service,
research indicates re-contact rates around 49% within 2 weeks.
Furthermore, overall referrals from WAST
to the community falls service reduced by 44%.

Approach

Using a Plan, Do, Study, Act (PDSA) cycle of improvement methodology, FRS paired a paramedic with a physiotherapist on an emergency response vehicle. Physiotherapists with specialist experience in falls assessments and referral pathways were selected. FRS responds to acute falls with the following aims:

1. Reduce ED conveyance rates by providing care closer to home.

2. Reduce re-contacts with ambulance service.

3. Reduce inappropriate referrals to the Community Falls Service.

4. Improve patient experience by providing a timely, holistic assessment and treatment.

The FRS team operates daily from 8am - 8pm. Calls are allocated via:

• Clinical Control Centre allocates non-injury falls.

• FRS crew self-allocates with access to call waiting stack.

• Ambulance crews refer appropriate patients.

On arrival, the paramedic assesses the patient´s medical stability. If stable, the patient is lifted using specialist equipment. The physiotherapist assesses mobility, function, environment and social support. A shared decision is made between the physiotherapist, paramedic, the patient and their carer(s). Where appropriate the patient is issued with basic equipment such as a walking aid or commode, given falls prevention advice and/or referred to local services.

Outcomes

FRS attended 479 falls (October 2016 - March 2017). 79% of FRS patients remained at home, compared to 35% of falls attended by non-FRS crews. Only 37% of patients who remained at home attended hospital within a month. While it has not been possible to compare this to the core service, research indicates re-contact rates around 49% within 2 weeks.

483 referrals were made to community services through pathways not available to core emergency vehicles, most commonly GP´s (128), community therapies (104) and social services (69). Furthermore, overall referrals from WAST to the community falls service reduced by 44%.

Qualitative evaluation indicates high patient satisfaction with the service.

Implications

Collaboration between paramedics and physiotherapists provides significant benefits to the patient, providing alternatives to ED such as basic equipment, falls prevention advice and onward referral to community services. This results in more patients treated at home, enabling frontline services to treat those with the greatest health need first.

Service evaluation highlights opportunities for physiotherapists to use our unique assessment skills within a new clinical setting. Further work must be conducted to establish best practice guidelines and establish appropriate scope of practice.

Funding acknowledgements

Funded by the Welsh Assembly Government Integrated Care Fund in collaboration with ABUHB and WAST

Additional notes

This work was presented at Physiotherapy UK 2019