Approaching Falls in Bromley care homes: Doing more vs doing most?

Introduction
Falls account for 27% of ambulance conveyances to hospital from care homes and Extra Care Housing (ECH) in Bromley, despite ongoing falls prevention and management efforts under the Enhanced Health in Care Homes Framework. In March 2025, a system-wide quality improvement programme was designed to super-charge falls prevention, reduce hospital attendance and improve post-fall care.

Methods
A multidisciplinary network (care home teams, GPs, community services, acute hospital, and ambulance teams) co-designed the Falls Campaign. This enabled risk stratification of falls and sequelae and generated an algorithm for proportionate assessment and response. The campaign included a falls prevention bundle that non-clinical teams could implement. Additionally, a direct-access Frailty same-day emergency care pathway was developed for people with falls and head injuries on anticoagulants.

The campaign was shared with all care homes and ECH settings via an interactive webinar and video. However, more intensive engagement was required to make an impact. Therefore, the top 20% of settings accounting for falls-related ambulance callouts (n=7) received focused support. These settings had 1:1 support, education sessions, and data support. Five settings participated in a Raizer chair study, receiving the equipment and training to help residents up after a fall without a long lie. Furthermore, six settings switched to decaffeinated drinks in December 2025 to reduce falls related to night-time toileting.

Results
Was there a reduction in falls in the intervention group?

Over eight months, falls-related ambulance conveyances reduced by 20% in the intervention group (vs. an 11% reduction across all care settings). Ambulance attendance was avoided for 91% of falls where a Raizer chair was used.

Conclusions
Care home teams respond positively to support and innovations in proportionate falls management and prevention strategies. However, targeted intensive engagement and interventions achieve greater success than generic approaches in embedding sustainable change.