The English and Welsh National Audit of Inpatient Falls – Six Years Using Data to Drive Improvement

Introduction

Falls are common in inpatient settings and are associated with poor outcomes. Evidence demonstrates multifactorial interventions to address fall risk factors are effective, and as such, have been incorporated into national and international guidelines. However, these complex interventions are difficult to implement at scale in hospitals. Continuous audit with embedded quality improvement is one method for implementation and scaling up complex interventions. 

Methods 

The National Audit of Inpatient Falls (NAIF), funded by the Healthcare Quality Improvement Partnership and run by the Royal College of Physicians, audits inpatient fall prevention actions and immediate post-fall management in older people who sustain fall-related injuries as a result of an inpatient fall in all English and Welsh hospitals. Key Performance Indicators (KPIs) are based on NICE quality standards for falls and  shared with hospitals via live dashboards, trust reports and an annual state of the nation report. 

Results

Continuous data collection for inpatient hip fractures started in 2019.  Around 2000 inpatient hip fractures happen each year, 85% of which are attributed to an inpatient fall. Audit completion rates are high and engagement with the programme is good. 

KPI 1, Multifactorial Assessment to Optimise Safe Activity indicates that ≥5/6  assessments were performed before the fall.  Nationally, this has risen from 31% in 2021 to 43% in 2024. KPI 2 evaluates effective initial check for injury, KPI 3: safe movement from the floor and KPI 4: medical examination, all after the fall. These increased from 69-79%, 22-38% and 52-74% respectively between 2019 and 2024. 

Discussion

The NAIF audit has driven improvement in assessment and management of falls through data, provision of resources and support for quality improvement through regular webinars. In 2025, the audit expanded to cover more fall-related injuries. Data analysis on this will begin in 2026.