Helping older people stay safe reduces demand on A&E

A day hospital in Cardiff is reducing visits to A&E through an integrated healthcare programme that helps older people reduce their risk of falls.

For an older person, a fall can be the start of a long-term decline in health. After falling, many people lose their confidence and end up housebound and isolated. So, reducing the risk of falls is an important factor in helping older people remain healthy and independent.

But it’s not straightforward. Falls are often caused by a combination of many different things, including side-effects of medication, low blood pressure, poor muscle tone and unsafe environments.

Falls prevention programme

If an older person has fallen, they may be offered a place on an eight-week falls prevention programme, where they learn exercises to improve strength, balance and mobility. They also get advice on tackling risks such as clutter and stairs, to make the home safer, supported by home visits.

‘Patients get a lot out of the falls groups – they don’t feel so alone,’ says Jo Murison, Senior Occupational Therapist. ‘One patient said “It has given me my life back”.’ The peer support within the group is an especially important aspect of the programme, Jo explains: ‘People are more likely to take the rugs up in their home if someone in their peer group tells them to do it than if we say it.’

Making use of data

In 2011, the service began working to improve the way it used data, and the following year launched a database that holds all the information about falls-related history and assessment information in one place. Being able to easily analyse data has enabled the hospital to monitor the number of falls and A&E admissions among patients before and after treatment, and to implement and test improvements using Plan, Do, Study, Act (PDSA) and Situation, Background, Actions, Recommendations (SBAR).

One such improvement is that the physiotherapy team now follows participants into the community to ensure that their progress over the eight-week falls prevention programme is sustained. ‘We make monthly phone calls to check that participants are still well and keeping up their strength and balance exercises,’ says physiotherapist Jane John. ‘If someone has stopped their exercises, a phone call helps to motivate them again, and we can even send a physiotherapy technician to do one or two sessions to get them started again.

‘We can do about 15 phone calls in an hour, so it’s a very cost-effective way of maintaining motivation and monitoring progress. It’s amazing the support you can give in one short call.’

In another example of its proactive approach to improving safety, the hospital worked with partners in A&E, community teams and other day hospitals to develop a validated screening tool, using PDSA cycles, to identify people at higher risk of falling. They can be invited to attend the John Pathy Day Hospital for assessment and support.

Improved patient confidence

‘The new system has really changed things a lot,’ says Jo Murison. ‘We can now get a full overview of what the nurses, doctors and physios have been doing with a patient, all in one place. We use a standardised, validated outcomes measure called the falls efficacy scale to measure people’s confidence in carrying out everyday tasks without falling. We can now see that the average patient confidence improves by 15% between the start of the programme and four months after completing it.

‘However, the real score is likely to be higher,’ explains Jo. ‘It’s a subjective outcomes measure, and we believe that a lot of people give themselves a low score as they don’t want to leave the programme.’

A vital aspect of the new system, particularly in the current economic climate, is that is can instantly create graphs and spreadsheets showing outcomes. ‘We have already reduced re-attendance in A&E of our own patients by two-thirds, from the time of discharge to their review six months later,’ says Jane. ‘The feedback we received from patients told us that we were succeeding, but now we have the evidence to back this up.’