42HEAD INJURIES IN OLDER PEOPLE: IMPROVING THE PATIENT PATHWAY INTO THE FALLS SERVICE AND INCREASING GERIATRICIAN INVOLVEMENT IN CARE

Abstract

Topic: Older patients presenting with head injury to Croydon University Hospital (CUH) are either admitted under non-geriatric teams or discharged with no set pathway into the falls service. We assessed the quality of care against NICE Guideline 161: "Falls in older people" (NICE, 2013) for patients aged 65 and over, making changes to improve the pathway and patient management. Intervention: We reviewed all 74 admissions aged over 64 to CUH with head injury over three months (01.01.18-31.03.18). Seventy-two (97%) resulted from a fall; only 1 had Falls Clinic follow-up. During admission (mean length of stay 9.3 days), cognition was assessed in 65% (38% of whom had delirium), and 39% received a comprehensive medication review. Assessment of continence, vision, or bone-health occurred in 36%, 14%, and 9% of patients respectively. 65% were reviewed by physiotherapy, 42% saw occupational therapy. Six patients died in hospital, and 37% of those discharged were readmitted within 90 days. Departmental performance between medical and surgical/orthopaedic admissions was similar. Within the same period, 101 older patients with head injury were discharged directly from the emergency department: just 7 were followed-up in clinic. Improvement: We presented our results to the Trust Clinical Governance committee and incorporated the findings into a Falls Service business case for the Clinical Commissioning Group, acquiring funding for an additional clinic and therapist. All head injuries in older patients due to falls will now be referred from A&E to the Falls Clinic, and admissions will be under joint care with Geriatrics. The pathway will be re-audited in future. Discussion: Opportunities to improve inpatient comprehensive geriatric assessment and onward referral to the falls service clearly exist. Head injuries in older people usually result from falls, and frailty is prevalent in this patient group: they should be incorporated into local falls pathways for maximum benefit.