To Convey Or Not To Convey: Falls with confirmed or suspected head injury pathway

Abstract Content :

Introduction

Falls in the elderly over the age of 65 are common, and the prevalence increases with age.  Current NICE guidance on managing falls involving head injury in patients receiving anticoagulation can be challenging to interpret. Combined with increasing pressures on ambulance services and emergency departments (EDs), this prompted development of a collaborative admission avoidance pathway.

Methods
A joint head injury pathway was developed by the Royal Berkshire NHS Foundation Trust (acute hospital), Berkshire Healthcare NHS Foundation Trust (community physical and mental health services), and South Central Ambulance Service (SCAS). Referrals are made to the Single Point of Access by community healthcare professionals for patients with confirmed or suspected head injury following a fall who have no red flags requiring acute admission.

The pathway enables acute and community clinicians to jointly assess patients and develop an individualised holistic management plan in partnership with patients and their carers. This avoids automatic conveyance to hospital for further assessment and CT head imaging. Patients receive safety netting advice and an escalation plan before follow-up within 48 hours by the Hospital at Home team or the Rapid Access Care of the Older Person Clinic for comprehensive geriatric assessment (CGA). Outcomes were reviewed at 7 and 28 days.

Results

Over a 10-month period, 274 referrals were received and discussed, resulting in the avoidance of 170 ED attendances and ambulance conveyances. Follow-up demonstrated very low rates of adverse outcomes related to head injury. Subsequent hospital presentations were predominantly attributable to unrelated medical, functional, or social issues. CT imaging rarely identified acute intracranial pathology, and no missed clinically significant intracranial haemorrhage, avoidable mortality, or serious patient safety incidents were identified.

Conclusion

By sharing clinical responsibility and working collaboratively across acute, community, and ambulance services, selected older adults experiencing falls can be safely managed at home while receiving timely comprehensive geriatric assessment. The pathway has demonstrated admission avoidance can be achieved safely, reducing unnecessary hospital attendances while delivering person-centred care. Clinician confidence in the pathway has increased over time, reflecting its effectiveness and sustainability.