Best Practice at Welsh Ambulance Services NHS Trust
The WAST Falls Response Framework
The issue of falls is complex. The people who require our help are often elderly, frail people. The fall may be a consequence of multiple clinical and social factors, or in some cases the fall is the start of a catalogue of events leading to increased frailty.
About our Falls Framework
The Falls Framework and Falls Response Model are intended not only to provide clarity within the organisation but to inform our partners when developing local services.
A review of our themes and trends from concerns/complaints, incident reporting and Serious Adverse Incidents has highlighted that the issue of falls is a recurring cause for concern with timeliness of response being a recurring theme.
We have developed a model that recognises that not all falls will require an emergency ambulance response and that many people who have fallen do not need to be conveyed to hospital.
The Welsh Ambulance Service Falls Response Model has been developed with Prudent Healthcare principles.
Developing a proportionate Falls Response
In developing our Falls Response model, our intention was to communicate clearly across our organisation and service users how we respond to people who have fallen. Our framework and model structures how the organisation responds to falls incidents, and where our services and initiatives are positioned to best serve our patients.
Level 1: Non-injury Fall
Our Level 1 response is described as a Falls Assistant. The Falls Assistant’s provide an initial response to safely lift patients from the floor where there are no injuries or a minor injury as a result of a fall. Following assessment they will be supported in their assessment at scene by the Clinical Support Desk where a Paramedic or Nurse provides clinical advice and direction.
Our CFRs and our UCS crews attend such calls, supported in their assessment at scene by the Clinical Support Desk provides advice and direction.
This response can also be provided in partnership with other agencies. In partnership with the St John Cymru Wales and health boards, there are now Seven Falls Assistants working across Wales providing support across five health board areas. During October – December 2018 the teams attended 771 patients across Wales.
Level 2: Possible Injury Fall/Complexity
Level 2 response is required either where it is unclear if there is an injury or not or where the person has co-morbidities or complex needs. A level 2 response is where a multi-disciplinary team can undertake a comprehensive assessment of the person in their own home and implement an appropriate care plan according to their individual need.
Currently within the Aneurin Bevan University Health Board a Falls Response Service (FRS) has been operating since October 2016 and consists of a Paramedic and Physiotherapist operating daily. This has been supported by the Welsh Government Integrated Care Fund. The FRS have had involvement with 1961 falls incidents received via the 999 system from October 2016 up to 31st December 2018. 1475 people (75%) have remained at home following assessment and/or treatment by the team with the appropriate care being provided by community based services.
Only 486 individuals (25%) required further treatment and/or treatment at hospital, and only 17% of individuals attended required treatment within the Emergency Department
Level 3: Injury Fall
Where a Hear and Treat assessment has identified that a person has suffered an injury as a result of a fall, an emergency ambulance response will be deployed.
Within this part of the model, effective pathways need to be in place. Such pathways ensure that people are admitted to the right place and avoid, where possible, busy Emergency Departments at a hospital.
Our Framework and Model is intended to provide clarity and direction in an area that is increasingly complex and where there is widespread variation.
What next for the WAST Falls Framework?
The team and wider colleagues supporting the Falls Framework continue to measure, monitor and improve the model through quality improvement methodology. Further tests of change, refinement and data will enable to team to implement and scale the model across Wales.
As part of the UK-wide collaborative Project A, coordinated by NHS Horizons, the WAST Falls Team have significantly contributed to the wider UK falls agenda. In early 2019, the Project A Falls collaborative met in London where the WAST Falls Framework formed a basis of discussion and outputs for ambulance services across the UK.
WAST Falls Key Contacts
|Claire Roche||Assistant Director for Quality Governance & WAST Falls Group Chair|
|James Gough||Project Lead for Falls Response
(Welsh Ambulance Service & Aneurin Bevan University Health Board)
|Jonathan Turnbull-Ross||Head of Quality Improvement|