Bridging Surgical and Geriatric Care: Improving Key Elements of Falls Assessment for Older Adults Admitted Under General Surgery

Introduction:

We undertook a two-cycle quality improvement project in a district general hospital to improve completion rates for basic post-fall investigations in patients aged 65 years or older admitted to the General Surgery department for conservative management of head injuries or rib fractures sustained due to a fall. This is a vulnerable group of patients with extensive medical comorbidity and often a medical cause for their fall, yet their care takes place outside a geriatric service. Based on British Geriatrics Society and NICE guidance, we implemented pragmatic educational and awareness interventions, aiming to improve completion of key components of a post-fall assessment: a falls history, falls examination, ECG and lying-standing blood pressure. These provide a framework for further falls assessment and interventions to reduce future falls and functional decline.

Method:

We collected data retrospectively from the hospital’s electronic patient record system, identifying 20 patients admitted between 13/11/2024 and 19/02/2025 for the first cycle, and 20 patients admitted between 04/10/2025 and 10/12/2025 for the second cycle. We included patients aged 65 or older who sustained a head injury or rib fracture after a fall and were admitted under General Surgery. We collected data on completion rates of falls history, falls examination, ECG and lying-standing blood pressure. Interventions included educational presentations for General Surgery doctors and a poster.

Results:

There was an improvement in completion rates of all four components: falls history taking from 50% to 75%; falls examination from 30% to 60%; ECG from 35% to 45%; and lying-standing blood pressure from 20% to 35%.

Conclusion:

This demonstrates that pragmatic and targeted interventions can improve completion of recommended post-fall assessment for patients admitted outside of a geriatrics service. We aim to sustain improvement by maintaining the poster and registering the project with the quality improvement team for further cycles.