Improving inpatient falls reviews: a quality improvement project at the University Hospital

Introduction

Inpatient falls occur frequently with over 27,000 falls reported in Scottish hospitals annually (1). Inpatient falls can lead to adverse health-related outcomes and increased healthcare-related spending in older people. A thorough post falls assessment, as recommended by The World Falls Guidelines Task Force, is vital to characterise the fall and any preceding factors, ensure injuries are not missed and prevent further falls (2). Structuring medical records can improve patient outcomes and doctors’ performance (3). Our overall aim was to improve inpatient falls assessment and management.

Method

This quality improvement project took place from 2024-2025 within the Medicine for Older Adults (MOA) wards in University Hospital Wishaw. Patients who had fallen and were registered on the online incident reporting system with complete information were included. Two PDSA cycles were completed. The initial intervention was designing and distributing a falls proforma, and the second intervention was promoting it. We collected data on documentation of lying and standing blood pressures, neurological examination, neurological observations, medication review, CT Head requests, and ECG performed at the time of the fall.

Results

We obtained complete data from 80% of the case notes. Following the first intervention, documentation in all domains increased. Most notably, neurological examination increased from 28.6% to 69.7% and ECG performed went from 0% to 39.4%. With the second intervention, the number of falls proformas completed decreased from 27.3% to 11.8%, but we found that elements of the falls proforma were being incorporated into clinicians' falls reviews.

Conclusion

This proforma can act as an aide memoire for the busy clinician on call. We found improvement in many domains even in those who did not use the proforma implying that clinical knowledge was improving. The next steps would be further promotion of the proforma, including non-MOA medical wards and completing further PDSA cycles to ensure effective implementation.