40FALLS RESPONSE SERVICE: A NOVEL MULTIDISCIPLINARY APPROACH IMPROVING PATIENT-CENTRED CARE FOLLOWING AN ACUTE FALL

Abstract

Background: The Falls Response Service (FRS) is collaboration between Aneurin Bevan University Health Board (ABUHB) and the Welsh Ambulance Services Trust (WAST). Introduction: Falls have a devastating effect on frail people, accounting for 10% of 999 calls received by WAST. High rates of conveyance (72%) to Emergency Departments (ED) were identified, with many conveyed with no injury due to lack of appropriate support to remain home safely. A previous trial pairing a paramedic with a patient transport assistant identified the need for specialist falls assessment, provision of basic equipment and appropriate referral pathways to local services. Methods: Using a Plan, Do, Study, Act (PDSA) cycle, FRS paired a paramedic with a physiotherapist on a response vehicle. Physiotherapists were selected from the Community Resource Teams (CRTs) with specialist experience in falls assessments and local referral pathways. FRS responds to acute falls with the following aims: (1) Reduce ED conveyance rates. (2) Reduce re-contacts with ambulance service by accessing local services. (3) Reduce inappropriate referrals to Community Falls Service. (4) Improve patient experience by providing timely response, holistic assessment and treatment. Interventions: The FRS team operates from 8am - 8 pm, 7 days per week. Calls are allocated as follows: • Clinical Control Centre allocates non-injury falls to FRS. • FRS crew self-allocates with access to call waiting stack. • Ambulance crews refer appropriate patients to FRS. On arrival, the paramedic assesses the patient's medical stability. If stable, the patient is lifted using specialist equipment. The physiotherapist assesses mobility, function, environment and social support. A shared decision is made between the physiotherapist, paramedic, the patient and their carer(s). Where appropriate the patient is issued basic equipment, given falls prevention advice, and/or referred to local services. Results: FRS attended 479 falls (October 2016-March 2017). 79% of FRS patients remained at home, compared to 35% of falls attended by non-FRS crews. 483 referrals were made to community services, most commonly GP's (128), Therapies (104) and Social Services (69). Only 37% of patients left at home attended hospital within a month. Furthermore, referrals from WAST to CRT Falls Teams reduced by 44%. Conclusions: Collaboration between Paramedics and Physiotherapists provides significant benefits to the patient, providing alternatives to ED such as basic equipment, falls prevention advice and referral to community services. This results in more patients treated at home, enabling frontline services to treat those with the greatest health need first.