A Rapid Community Response to Long Lies in Frail Patients: Reducing Hospital Admissions. A Prospective Service Evaluation.

Admission Avoidance Through WROLL

Background:
Falls are common in older adults, with up to 35% of those aged ≥65 years falling each year. A long lie remaining on the floor for over 60 minutes conveys serious risks, including infection, muscle injury, functional decline, and hospitalisation. The Wigan Reduction of Long Lie Service (WROLL) was set up to respond quickly to these events and reduce unnecessary admissions.

Methods:
We prospectively evaluated 49 patients referred to WROLL. We recorded demographics, frailty scores, fall circumstances, length of lie, frailty blood tests, including CK, underlying medical contributors, and interventions provided.

Results: 
Patients were aged 22–100 years, 55% female, and all frailty score≥4. Most falls occurred indoors, mainly in bedrooms and bathrooms, with 63% at night. A prolonged lie occurred in 92%, with 18% on the floor >10 hours. Contributing factors included infection, postural hypotension, polypharmacy, and mobility limitations. Interventions focused on rapid assessment, treatment of underlying causes, medication review, hydration, and early therapy input. As a result, 69% of patients were safely managed at home; 31% required hospital admission.

Conclusion:
Falls with prolonged immobilisation are a serious risk in frail older adults. A timely and comprehensive response that addresses underlying medical, social and mental causes can significantly reduce time on the floor and support hospital admission avoidance, improving patient outcomes and experience