Abstract
Background
This QIP was conducted in the Older Person Assessment Unit (OPAU) at Whipps Cross Hospital, acute care unit serving a diverse older adult population in East London. The project was led by resident doctors under consultant supervision.
Introduction
Falls are a leading cause of admission to the unit, contributing to injury, prolonged hospitalisation, and physiological decline. NICE CG161 provides evidence-based recommendations for risk prevention. Inconsistent documentation and low referral rates for preventative measures contributed to varied care quality and reduced effectiveness in fall secondary prevention. Our aim was to identify gaps in clinical practice and recommend strategies to improve adherence to NICE CG161.
Methods
A two-cycle retrospective audit was conducted on patients aged 65–101 admitted with a fall. Cycle 1 (July–October 2024) reviewed 30 patients to identify areas of low compliance, including Comprehensive Geriatric Assessment (CGA), Clinical Frailty Scale (CFS), FRAX or Q-Fracture, Home Environment Hazard assessment, Strength and Balance Training referrals, and outpatient referrals. Interventions comprise a structured falls assessment checklist and targeted staff training. Cycle 2 (January–March 2025) audited another 30 patients to compare documentation rates post-intervention.
Results
Post-intervention, documentation improved significantly. CGA completion rose from 33.3% to 90%, CFS from 66.7% to 90%, and FRAX from 16.7% to 80%. Home hazard assessments achieved 100% compliance. Referrals to Strength and Balance Training increased modestly, from 40% to 46.7%. Patients benefitted from structured assessments, though referral actions remained inconsistent.
Conclusions:
Training and checklists improved documentation but did not significantly impact referral rates. Future improvement cycles will focus on training in line with recently updated NICE guidelines, include process metrics – around bone protection measures, referrals for strength and balance training, home environmental adaptation and medication changes. Long term we aim to use outcome metrics around 7 and 30 day falls readmission rates to better understand outcomes.
Comments
Referral question
Hello. Thank you for presenting your quality improvement work. Who were the referrals made to, in order to reduce future falls risk? What is the purpose of the outpatient referrals? Are these referrals to Falls clinics, physiotherapy clinics or something else? What impact does the clinical frailty score have on outpatient referrals or other interventions? Thank you.
Hello. Thank you for your…
Hello. Thank you for your time to go through our work, and I appreciate your response.
In our project, patients identified through the falls audit were referred to the Falls Clinic and Community Physiotherapy services for further assessment and management. The Clinical Frailty Score (CFS) provided a structured framework to guide these referrals and ensure that interventions were tailored appropriately to the individual’s level of frailty. By integrating the CFS into referral pathways, we were able to demonstrate that patients were directed towards the most appropriate services for their level of frailty. This ensured more efficient use of outpatient resources, promoted safe community management, aligned interventions with patient needs and reduced repeated hospitalisation.
Thank you for your poster,…
Thank you for your poster, what did the training consist of and who was this provided to?