Are Inappropriate Referrals Really Inappropriate? Evaluating an Open Referral Pathway to a Community Falls Assessment Service

Introduction 
Our  Falls Service utilises an open referral pathway providing rapid access to multi-factorial assessment. Restrictive eligibility criteria, such as falls history, may limit opportunities for earlier identification of risk factors. Evidence and clinical experience indicate that individuals without previous falls can still benefit from comprehensive assessment. Community-based assessments facilitate identification and management of falls risk, incidental findings, delivery of tailored education, advice and appropriate onward referrals. This evaluation examines the clinical value generated by referrals to a community falls service operating an open referral model. 

Methods 
A retrospective evaluation was undertaken of 122 referrals to a community falls clinic between 1 July 2025 and 30 September 2025. Patients referred had a mean age of 78 with age ranging between 41 and 95. 76% of referrals received were female and 24% male. Data collected included falls history, modifiable risk factors, incidental findings and onward referrals.  

Results 
Of the 122 referrals received, 90 patients (72%) received an assessment.  All assessed patients (90/90) had at least one modifiable falls risk factor identified during comprehensive falls assessment. One or more modifiable risk factors were identified at assessment for the 8 patients reporting no falls in the preceding 12 months. These included mobility impairment (n=8), bone health risk (n=3), medication-related risk (n=3) and the need for onward referral for balance classes (n=3). 79% of all patients (n=71) had onward referrals identified. Incidental findings included bone health (n=30) and medication (n=25) management and advice. Subjective clinical benefit from attendance at the Falls Clinic was identified in 99% of patients (n=89). 

Conclusion 
An open referral pathway identified patients with clinically relevant and modifiable falls risk factors, including individuals without a recent history of falls. Broad referral criteria facilitated preventative intervention, identification of incidental findings and appropriate onward referral, demonstrating clinical value without generating significant inappropriate demand. 

Ethics statement 

This project was registered locally as a service evaluation. It involved retrospective analysis of routinely collected clinical data and did not involve any change to patient care. In accordance with HRA guidance, formal NHS Research Ethics Committee approval was not required.