1. Dundee Falls Project
Paul Moran
Feb 2013

2. Today’s Presentation Background information What is a Fall
Falls statistics
Projects
Pathways
Ninewells Accident and Emergency Pilot
DIAL – OP involvement

3. Who I am Physiotherapist with CRT
Working as Dundee’s Falls Co- ordinator since 1st August 2012
Aim
Develop a Falls Pathway
Promote Exercise/Falls Prevention

4. “A Fall is a symptom, not a diagnosis”
Falls
“A Fall is a symptom, not a diagnosis”
The causes of Falls can be:
Extrinsic: e.g. trips and environmental hazards
Intrinsic: e.g. muscle weakness, loss of balance, impaired vision, medication related
Combination of both
Each fall is significant – a person who has fallen once is more likely to fall again!

5. Falls Statistics Falls are a significant cause of hospital admissions
In the UK
Fracture hip every 10 minutes
Fracture spine every 3 minutes
Fracture wrist every 5 minutes
Significantly, over 40% of those who fall reduce their activity due to fear of further falls
On average 50% of all falls occur in the persons own home
It is estimate that 75% of falls are NOT reported

6. Dundee Statistics In Dundee, on an annual basis
30% of >65 years will fall (approx 8,000 people)
There were over 7,800 A&E admissions to Ninewells in 2011 as a result of a fall
22 per day
999 calls for Falls in Tayside (approx 3,600)

7. Projects Investigate Dundee’s current pathway Stakeholder event
Test of Change
Accident and Emergency
Social Care Response
Falls Clinic referrals
Single Point of Access
Community Falls Prevention classes
OTAGO training

8. Dundee Falls Pathway – Current State
Patient
Falls
Ambulance
Community
Alarm
Warden
A&E
See and treat
First Contact Team
Fracture clinic
Discharge
Medical
wards
Orthopaedics
Home
RVH Falls Clinic GP
CRT
District Nurse
Psychiatry, Specialist Service
Pharmacy
Care Manager, Social Work
If has active worker
Key
Blue – Health
Yellow – Social Work
Community support,
Home Care/Enablement/Care Home

9. OTAGO Community classes
Dundee Falls Pathway – Future Pathway
Older Person Falls
Falls causing concerns:
Community Nurse
Community AHP
Care Worker
Community Alarm
Sheltered Housing Warden
Care Home Staff
A&E
Ambulance
GP/Self/Carer
Hospital
In-patient
Fracture Clinic
Single Point of Access
To Falls Service
Triage / Sign-posting
Professional/Agency referral
Physiotherapy
Occupational Therapy
Podiatry
Pharmacy
Care and Repair
Care Management
RVH Falls Clinic
Exercise Options
OTAGO Community classes
C.A.N. Exercise database

10. A&E Pilot Background
In 2011, there were 7868 attendances at A&E as a result of a fall
On average, this is 21.6 per day
In 2011, 7031 of these attendances were discharged home following assessment at A&E
In 2011, over 65’s accounted for 52% of these attendances
Month
2009
2010
2011
Jan
551
586
787
Feb
548
501
498
Mar
715
587
648
Apr
668
540
653
May
687
692
735
Jun
693
642
650
Jul
625
631
610
Aug
629
621
675
Sep
632
677
Oct
558
576
634
Nov
529
545
Dec
566
727
756
Total
7401
7277
7868

11. Attendances Trend

12. Outcome of Triage

13. Outcome of Triage
Approximately a third of patients telephone triaged did not require any further follow up
Approximately a third were sent a Falls pack for further information
43 were referred to physiotherapy either at Kings Cross as an outpatient, or CRT
15 were advised to contact their GP’s with a view of further investigation
These 15 would possibly have been considered for referral to RVH Falls Clinic
A low number were referred to locality Pharmacists due to difficulties identifying appropriate patients
4 or more medications Vs. Combinations of medications

14. Breakdown of “Other” outcome
During the screening process 24% were already known to a service
Due to initial problems checking MiDIS and Social Work Database (K2), it would be expected that a greater number may have been known to these services.
“Other”
Number
Day hospital 8
Parkinson’s clinic 5
Physiotherapy 22
Care Manager 11
Admitted 6
Repeat 4
District nurse 10
No consent 1
Audiology/ENT
Liff
PICU
Deceased
Falls clinic referral

15. DIAL – OP Involvement Back to original aim:
“Promote exercise and Falls prevention
Falls Pack
DIAL-OP card
Falls leaflet
Self referral form for Physiotherapy
New Falls “Magazine”
Information on services
Referral forms
Adverts

16. DIAL – OP Involvement Signposting
If a person has fallen direct to Single Point of access
Triage referral: Will make onward referral to appropriate service such as physiotherapy, OT, social care response, social work OT, district nurse, poly-pharmacy review”
If the person is simply looking for community exercise, please direct via the database of community exercises

17. Contact Information
Single Point of Access is currently based at Royal Victoria Hospital
Mail: Early Intervention Hub, Royal Victoria Hospital, Jedburgh Road, Dundee, DD2 1SP

18. Any Questions ?