Community teams, specialist fall services and emergency department implementing an integrated regional falls risk assessment and prevention pathway

摘要

Introduction : In 2008, the national strategy for the prevention of falls and fractures in Ireland was published. In 2009, a detailed mapping exercise in our region demonstrated the size of our problem showing 4,680 emergency department attendances locally for falls annually, 21,500 acute bed-days used after falls and falls-related local health cost of €31 million. We had elements of good practice but services for falls management were neither coordinated nor integrated. Practice change : We took a whole-system approach to the delivery of services for falls in older people. Since 2012 a multidisciplinary clinician group has worked with regional management to improve falls services. Our project has four main work streams: building community capacity for fall risk assessment; re-engineering specialist fall services to improve access; standardising continuing care falls assessment; and promoting healthy ageing to prevent falls. Aim : We aim to deliver 1,300 additional multifactorial fall risk assessment places yearly. Our objective was to implement an integrated pathway between emergency department, community services and specialist services for falls prevention. Targeted population : Our catchment population has ~300,000 people in mixed urban and rural settings. A large stakeholder workshop was held in July 2014. The change management process is coordinated through monthly steering group meetings along with weekly teleconferences with four project work-streams leads. Highlights : In 2015, a regional falls coordinator and an administrator were appointed. The continuing care work-stream has separate funding, allowing an experienced nurse support 17 community units for 12 months to implement a standardized approach to falls. Otherwise, all developments were within existing resources.