Standardising Multifactorial Falls Assessment in a Consultant-Led Outpatient Falls Clinic: A Closed-Loop Audit

Introduction

Falls are a leading cause of injury, hospital admission and loss of independence among older people. At the start of this project, NICE CG161 recommended comprehensive multifactorial falls assessment for older adults at risk of falls. During the second audit cycle, this guidance was superseded by NICE NG249 (2025). Review of the updated recommendations confirmed that the audit criteria and intervention still aligned with the current guideline. We evaluated documentation of multifactorial falls assessment and the impact of introducing a structured Outpatient Falls Risk Assessment Tool (OFRAT).

Method

A closed-loop audit was undertaken in a consultant-led outpatient falls clinic at Good Hope Hospital. The first cycle reviewed 50 consecutive clinic letters (October 2023–October 2024) against NICE-recommended assessment domains, including falls history, gait and balance, vision, cognition, medication review, cardiovascular assessment, osteoporosis risk, continence, functional assessment and home hazards. Following the baseline audit, OFRAT, clinician education, reminder posters and structured medication review using STOPP/START principles were introduced. The second cycle reviewed 41 consecutive clinic assessments (21 completed using OFRAT and 20 without OFRAT).

Results

Baseline documentation revealed substantial variation across assessment domains and following implementation of OFRAT, ther was marked improvement across all domains, with most exceeding the predefined compliance target of 70%. There was marked improvement in assessment of continence (+55.5 percentage points), home hazard assessment (+50.7), cardiovascular assessment and medication review (+41.0), and vision assessment (+40.7). In addition, completed OFRAT forms complemented clinic letters by documenting assessment domains that were not consistently recorded in routine correspondence, resulting in a more comprehensive record of multifactorial falls assessment.

Conclusions

Implementation of a structured outpatient falls assessment proforma was associated with improved completeness and standardisation of multifactorial falls assessment within a consultant-led outpatient clinic. Although designed using NICE CG161, the intervention remained fully aligned with the updated NICE NG249 guidance, supporting its ongoing use as a sustainable quality improvement intervention.