Hospital or home? Guidelines to assess older people who have fallen

Guidelines to help paramedics make the right decision for older people who have fallen are safe, cost-effective and help reduce further 999 calls, according to new research led by a team at Swansea University Medical School.

Falls are a very common problem in older people, with severe consequences. Many 999 calls are made for older people who fall. Many callers fall more than once.

• Approximately 30% of people over 65 living at home fall every year
• In the UK, falls account for almost £1 billion of the NHS budget
• Around 8% of 999 calls in the UK are for falls

If the person who has fallen is not injured they may be left at home by the ambulance crew, rather than taken to hospital. On average this happens in around 40% of cases currently. In some places ambulance services have made local links with community falls services. However, there is not enough evidence to show whether this is safe, effective for patients or worth the cost.

This is where the Swansea research comes in, part of a project called SAFER 2 (Support and Assessment for Fall Emergency Referrals). The team carried out a large-scale trial to test new guidelines - known as a protocol - for paramedics to use to assess people following a 999 call for a fall. The protocol helps them decide whether they should take the patient to hospital, or leave them at home with a referral to a community-based falls service if appropriate

The trial involved105 paramedics based at 14 ambulance stations, across three UK ambulance services. The team monitored over 4000 people who called for an ambulance after falling.

The research showed that the new protocol:

• Was safe and inexpensive
• Led to an 11% decrease in further 999 calls by people who have fallen - so there would now be 8 calls for every 9 made previously
• Left fewer people without continuing care after their fall

• Did not have any wider effects on Accident and Emergency admissions or death rates
• Had limited effects on patients' quality of life or satisfaction
• Was not used as much or as consistently by paramedics as expected

Professor Helen Snooks of Swansea University Medical School, who led the project, said:

"The findings show that this new way of assessing patients who fall is safe. Ambulance services can introduce it knowing that it does not increase the risk of harm to patients.

We also showed that the protocol was associated with a small reduction in 999 calls from patients who had fallen previously. As costs and pressures are so high in emergency care, even a small reduction can make a big difference."

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