A multi-cycle, multi-intervention QI Project improving the immediate assessment of inpatient falls across Cardiff and Vale

Introduction

The 2022 the National Audit of Inpatient Falls report suggested that “falls are the most frequently reported incident affecting hospital inpatients” with nearly a quarter of a million inpatient falls occurring each year in English hospitals. (RCP 2022)

Our local departments had identified variable completion in post-fall assessment, as well as confidence and training amongst nursing and medical teams. This multi-cycle, multi-intervention project initially started in our primary site. Using spread & scale we have worked collaboratively with our colleagues in Community and Tertiary sites to help implement adapted forms of the project

Methods

Using DATIX and inpatient notes, baseline data was collected in 2021 on inpatient falls assessments. This included documentation on high-risk injury assessments, manual handling methods, A-E assessments and more.

Starting in 2024, multiple staged interventions began on our primary site, with the aim of improving the above. These interventions included introduction of a Falls proforma and Action Cards (in collaboration with the Falls Strategy team and Quality & Safety team), SIM sessions for Resident doctors and SIM sessions for Nursing colleagues. Data on the above measures was re-collected following each Intervention, and 8 months later to look for sustained change. Total number of fall assessments reviewed was 104.

Results

Initial run data demonstrated improvement in certain areas. Documentation on high-risk injury assessments, prior to patient transfer, improved from 17% to 52%, 75% and 79% following each Intervention. However, this was not sustained at 8 months, dropping to 55%. This trend was seen similarly with A-E assessments, increasing from 32% to 88%, 89% and then dropping slightly to 76%. Due to sample size, data analysis on fast-track medical reviews (<30 minutes) in the presence of suspected high-risk injury, appropriate manual handling technique and delayed diagnosis of injuries was not possible.

Discussion

Whilst initially encouraging, sustained improvement remains challenging. Updated run data should help inform on future education and training, to ensure change is embedded.  Also, while there is evidence that documentation is improving, it is difficult to translate this to improved patient outcomes, given the small sample size. Positively, collaborative partnership has encouraged Spread & Scale of this QI across multiple sites, with future data to come.