Managing Falls- avoiding the need for conveyance to hospital with early community therapy and specialist paramedic intervention, a winter initiative.
Falls with minor injury are common within the ageing population and a common cause of fragility fractures. Following a fall many older people suffer a loss of confidence and reduction in independence and reduced function. Older people admitted to hospital following a fall may also experience further challenges such as hospital induced disability and deconditioning as a result of admission. SPPOT, specialist paramedic, physiotherapist and occupational therapist service was developed to provide a specialist intervention for the assessment treatment of people over the age of 65 who fall at home with the aim of reducing conveyance of this group to the emergency department.
A review of falls data across Oxfordshire was undertaken in partnership with South central Ambulance Service (SCAS) to establish the frequency, location and timing of calls to the ambulance service following a fall. Winter initiative funding was allocated to the ambulance service who seconded a physiotherapist and occupational therapist from the Community Trust to provide an enhanced service to assess, treat and signpost people who fall. The adapted ambulance car provided specialist equipment to get patients up safely from the floor following specialist paramedic assessment for injury. The therapy team undertake a comprehensive mobility and environmental assessment with the aim of delivering advice and interventions to reduce further falls. On going referral for further therapy interventions and assessment by the specialist falls team was completed if required.
Over a period of 5 winter months, 78 operational days, the service saw 132 patients who had fallen in their own home for assessment and intervention by the specialist team SPPOT consisting of specialist paramedic, senior physiotherapist or senior occupational therapist. 85% of patients were successfully assessed and treated at home - this is the non-conveyance group. 15% of patients were conveyed to a hospital environment, 18 to an acute hospital emergency department and two to the local Emergency Multidisciplinary Unit. For 23% of patients this was their first fall but the remaining 77% had previously fallen.
The SPPOT team attended a small proportion (132) of reported falls during the time period but of those that were seen 85 % were assessed and treated at the scene and not conveyed to the emergency department.585 were female and 425 male. Ages ranged form 45 to 97 years old. The SCAS paramedics report an increased knowledge of community therapy and other community services and as a result have an increased confidence to leave patients safely at home with early referral to community therapy and support services. Other benefits were improved patient and carer satisfaction and promotion of independent living. Reduction on pressurised emergency departments and core ambulance crews during peak operating periods was also acknowledged by the system as a benefit.
NHS Community and Ambulance Trusts should procure long term funding for a service that addresses the health and social needs of patients who fall in their own homes to reduce pressure on emergency services and enables earlier access to community services
This pilot project was made possible by funding from Berkshire, Oxfordshire and Buckinghamshire STP Winter Initiatives money.
This work was presented at Physiotherapy UK 2019