From Fall to Follow-Up: Improving Post-Fall Assessment Timeliness and Documentation with NICE and NAIF Standards

This project aimed to educate foundation (FY) doctors regarding post-fall assessments and develop a proforma to enhance documentation, within an acute hospital trust.

NICE Quality Standard QS86 for adults aged 65 and over in a care setting states that a fast-track examination (under 30 minutes) should occur for highly vulnerable patients, or those showing signs of serious injury. The National Audit of Inpatient Falls (NAIF) Report 2024 found that 65% of patients who had a fall-related inpatient femoral fracture (IFF) received a fast-track medical review. In our hospital this was only 30%. The NAIF Report recommends that patients experiencing an IFF should receive analgesia within 30 minutes, only 35% of our patient’s did.

We undertook an education session for 42 FY doctors, which demonstrated a paucity in knowledge regarding the NICE quality standards. Pre-education, only 55% of FY doctors were able to correctly identify patients requiring a fast-track medical review, and only 69% indicated that analgesia should be administered within 30 minutes.

Following education, understanding of guidelines improved to 93% correctly identifying patients requiring a fast-track medical review (93% vs 55% p=0.0001 Fisher’s exact test), and 93% correctly indicated that analgesia should be administered within 30 minutes (93% vs 69% p=0.0107 Fisher’s exact test).

Within the session, a post-falls proforma was developed collaboratively with the FY Doctors, to improve efficiency in documentation, and included a prompt for analgesia in the plan. 

Following the education and implementation of the proforma, we plan to re-audit in January 2026. We will review the time to medical review and analgesia administration, to identify improvements in patient safety. Following this, we will target other areas of the falls review requiring standardisation, such as neurological observations. For continued impact, education on post-fall assessments has been incorporated into the foundation teaching programme.