Innovative project helps reduce harm and hospital admissions after a fall

An innovative project which saw an 80 per cent reduction of ambulance callouts for falls which didn’t result in an injury has received national attention.

Staff from the health board, local authorities, the Welsh Ambulance Services University NHS Trust and care homes joined forces to help reduce the time spent on the floor after a fall for patients in community care settings.

The success of the collaborative approach has resulted in the project being shortlisted in the patient safety category at the Health Service Journal (HSJ) Awards.

Pictured: Melanie Harris (left) care home manager at Hengoed Court, with staff who have been trained to use the iStumble app.

It has also received recognition at the NHS Wales Awards (Quality and Improvement) in the whole systems approach category, for reducing harm by empowering domiciliary and care home staff.

The project has also seen the number of patients being taken to hospital after a non-injurious fall reduce from 60 per cent to just eight.

People who spend a prolonged time on the floor after a fall, known as a long lie, are at risk of a reduced recovery and an increased risk of hospitalisation.

They can also face a long-term care admission, as well as an overall loss of independence as a result.

Previously, it was a requirement that all falls in care homes and domiciliary care were reported to the ambulance service, regardless of injury.

This led to delays in receiving care and unnecessary hospital admissions, among other things.

The project aimed to address the avoidable harm experienced by older people, which also impacted healthcare, social care, ambulance services and care homes, too.

Eleri D’Arcy, Swansea Bay’s falls quality improvement lead, said: “Long lies can contribute to pressure damage, pain, dehydration, hypothermia, and psychological trauma.

“They increase hospital stay duration, reduce rehabilitation potential, and are a major factor in permanent care home admission.

“Data told us that 100 per cent of falls in care homes and domiciliary care triggered ambulance calls, 60 per cent of which were taken to hospital where the average stay was around 15 days.

“Not only did this impact the patients, but also the ambulance staff and care home staff who would be tied up at incidents for long periods.

“It was a shared problem which required multi-agency working between the health board, social care, ambulance and care providers to keep people well at home and avoid unnecessary admissions.”

To begin with, one domiciliary care provider gathered baseline data around the frequency of falls, ambulance calls, lifting attempts and time spent on the floor.

Senior trained staff used an app designed to guide them in community care settings through a health assessment after someone has had a fall.

Called iStumble, the app helps staff to make decisions around lifting residents and how best to react after a fall.

“We started by looking at whether non-injured individuals could be safely assessed and lifted by trained senior staff using the iStumble app and portable lifting equipment,” Eleri added.

“Staff were trained in-person by Swansea Bay manual handling leads, with support from primary care and safeguarding teams.

“Over three months there were 38 falls recorded and of those, 76 per cent were managed independently without any ambulance input.

“The average time spent on the floor reduced from 160 minutes to 45 minutes.

“Care staff were central to the change and their insights helped to shape the training and delivery of the project.”

After proving successful, it was decided more community-based care staff would be trained to use the app as well as lifting equipment.

Following this, just 25 falls were reported over a two-month period.

This time, 88 per cent were resolved without ambulance input and the average time spent on the floor reduced to 30 minutes.

Melanie Harris, care home manager at Hengoed Court in Swansea, was heavily involved in the project.

She said: “As a panel we looked at the app to see how we could avoid unnecessary hospital admissions.

“Staff now use the app and if someone has a fall it helps them through the process of how to assess them and what the next action should be, then it gives an outcome.

“It helps to talk staff through it all, which is great as staff are not qualified nurses in residential homes.

“The overall aim was to produce a more consistent approach to falls in care homes.

“Since using the app we have seen reduced hospital admissions and ambulance calls, and it has helped to keep people safe in their home.”

It was later decided to rollout the model to train more staff to be able to respond to falls using the app and lifting equipment.

Eleri said: “Patient and family feedback highlighted that quicker assistance preserved dignity and reduced distress.

“This second model showed that enabling wider responsibility among trained staff resulted in timely responses.

“To help roll it out, we carried out a mixture of in-person and online training for staff.

“Since launching the project we have seen an 80 per cent reduction in ambulance callouts, patients being taken to hospital has reduced from 60 per cent to just eight per cent, and the average time spent on the floor has reduced from 160 minutes to just 30.

“By learning and adapting together, we have created a model which supports better recovery and improves the experience of some of the most vulnerable people in our communities, all while reducing pressures on ambulance and healthcare staff.

“These improvements directly address the serious risks associated with long lies, such as pressure damage, kidney failure and deconditioning.

“Patients are now more likely to remain at home, preventing unnecessary hospital admissions and preserving their independence.”

Staff will attend both award ceremonies in the coming weeks to find out if they have been crowned winners.

“It is an honour to be shortlisted for both the HSJ Awards and the NHS Wales Awards in recognition of our work in falls prevention,” Eleri said.

“Change often starts with someone being willing to give it a go, and what we have achieved together is a testament to the passion, respect, and understanding of everyone involved.

“I am deeply grateful to colleagues and providers who have driven this project forward and continue to improve the experience of individuals who suffer a fall.”