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An Overview of Falls Assessment Clinics in Gloucestershire Denise Frost Irene Hardisty.

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1 An Overview of Falls Assessment Clinics in Gloucestershire Denise Frost Irene Hardisty

2 Despite the good mechanisms in place for identifying falls, it is not clear how widely used or effective they are, as the numbers attending falls clinics are surprisingly low (median 5 per week in consultant physician led clinics) considering that about 10,000 falls occur annually in the average sized PCT. National Audit of the Organisation of Services for Falls and Bone Health for Older People 2006 The National Perspective

3 Gloucestershire Falls Services Clinics Clinics rural and urban Leading professionals vary Collaborative working practices There are significant variations in how Falls Clinics are funded Patients On average, 2-3 patients seen in each clinic Patient groups predominantly female over the age of 75 We estimate that about 700 patients are seen annually Appointments can take anywhere up to 2½ hours

4 9 Clinics Countywide Physician Led Elderly Care Clinic Physio Led Coordinator Led Key

5 The Falls Clinics Clinic locationNo. of clinics per week No. patients per clinic Waiting timePhysician availability Dilke Hospital0.5 (every 2 weeks)44-6 weeksno Delancey Hospital133-6 weeksyes GRH – consultant led132 weeksyes GRH – physio led122 weeksNo Moore Hospital0.25 (one per month)3Up to 8 weeksYes Stroud Hospital222-3 weeksYes Tewkesbury Hospital0.6 (2-3 times per month) 33-6 weeksYes Cirencester Hospital – Elderly Care Clinic 122-6 weeksyes Stroud Hospital – Elderly Care Clinic 222-3 weeksYes

6 Referral Protocols Referrals from a wide range of professionals, but mostly from GPs Time from referral to assessment varies anywhere between 2-8 weeks Inappropriate referrals are being made Links are being made in some areas with A&E, hospital wards and fracture clinics, but these are inconsistent Ambulance services have no strategy for referring patients

7 Services provided at Clinics * Elderly Care Clinics ClinicConsultant /Physician PhysioRGNOTPharm- acist Clinic frequency No. patients per clinic Dilke01100Fortnightly4 Delancey11111Weekly3 GRH – cons11100Weekly3 GRH - physio01100Weekly2 Moore11110Monthly3 Stroud11110Weekly2 Tewkesbury111112-3 per month3 Cirencester*20100Weekly2 Stroud*11110Weekly2

8 Towards an understanding of the bigger picture June, July and August 2007 Total number of patients who have fallen – unknown! 548 hospital admissions 571 ambulance callouts 228 patients seen in FAC ?? ?

9 Issues for consideration (1) Standardisation of: Referral procedures Referrals from ambulance services Screening procedures Paperwork Access to a physician Waiting times Patient experience at a clinic Funding streams

10 Issues for consideration (2) Equity of service provision Identification of fallers Funding streams Developing sustainable pathways Location of clinics defined by need Links with A&E, wards and fracture clinics Assessments in primary care Doing things differently, e.g. using care homes

11 Active Balance Classes (1) Referrals mostly from FACs Waiting times anywhere from immediate start – 10 weeks Transport is an issue in some areas Classes are either on a rolling programme or run in blocks Many have an educational component 60% completion rate

12 Active Balance Classes (2) Initial improvement in strength and balance Improvement is not sustained if activities are not continued Access to community activities limited Anecdotal evidence from patients suggests that this type of activity is beneficial

13 Issues for consideration Transport issues How can mobility be maintained following the Active Balance Classes? Making links with community based activities that are appropriate to needs and affordable

14 Thank you for listening We are based at the Triservices and can be contacted: On global email or Telephone: 01452 753014/3015

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