Evaluating EDITH Service Adherence to NICE (2025) Community Falls Guidelines: An Occupational Therapy-led Quality Review

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Cliona Doyle1, Aoibheann O'Kane1, Finola Smith1, Sarah McNally1, Kim Tormon2, Dr. Niamh MItchell2, Arthur Doran2.
1 Occupational Therapy Department, St. Vincen's University Hospital, Elm Park, Dublin 4, Ireland, 2 Emergency Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
Clinical Quality
CQ - Patient Centredness
Falls
View DOI

Abstract

Background:
The Emergency Department in the Home (EDITH) service delivers urgent medical and occupational therapy (OT) assessment and intervention within older adults’ homes, offering alternatives to hospital conveyance. Falls account for approximately 22% of monthly referrals to EDITH. From an OT perspective, alignment with the National Institute for Health and Care Excellence (NICE) Falls Guidelines 2025 is essential for comprehensive falls management. This review assesses EDITH practice against four OT-relevant quality markers: frailty assessment, home environment assessment, cognitive screening, and referral to strength-and-balance exercise programmes.

Methods:
A 12-month retrospective review was undertaken. Inclusion criteria were adults aged 65 and over, referred by the National Ambulance Service (NAS) to the EDITH service with a fall as their primary presenting complaint. Thirty patients met the criteria. Electronic records were audited to determine completion rates for: frailty assessment; structured home environment assessment; cognitive screening; and referral or signposting to falls exercise programmes or other community services.

Results:
Twenty-eight of the 30 patients (93%) were seen by an OT. All OT-assessed patients (28/28; 100%) received a validated frailty screen and a home environment assessment. Cognitive screening was completed for 26/28 patients (93%). Sixteen patients (57%) received an onward referral to a primary care or community service; however, none were specifically referred to a recognised falls exercise programme, indicating a gap in alignment with NICE guideline recommendations.

Conclusions:

This OT-led review demonstrates strong adherence to NICE (2025) falls guidelines relating to frailty and environmental assessment within the EDITH service. However, referrals to evidence-based falls exercise programmes were absent, highlighting a key area for improvement. Strengthening referral pathways, enhancing staff awareness, and refining documentation processes are suggested to support full alignment with national standards and improve falls prevention outcomes.

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